Autism 202 for medical practitioners and other interested clinicians

Transcription

1 Wednesday, 2:30 4:00, F2 Objectives: Notes: Autism 202 for medical practitioners and other interested clinicians Mary P. Sharp MD Identify advances in clinical assessment and management of selected healthcare issues related to persons with developmental disabilities 2. Discuss co-occuring medical conditions and co-morbidity with autism 3. Outline components of the adult support system

2 Autism th Annual DD conference Kellogg Hotel and Conference Center April 23, 2014 Mary P. Sharp M.D. Autism Epidemiology Agenda 2. Co-morbidities and co-occurring disorders 3. Treatment options. 4. Adult service system. Epidemiology in 10,000 or 1 in 2,500 1 in 68 1

3 ts Number of student ,208 Michigan Students with an ASD Eligibility * Based on 2011 MDE, OSE Eligibility Count 15, Epidemiology Actuarial data supports life time cost of care, with out intervention 2.3 million dollars Current U.S. costs = $126 billion The Future?

4 CO-MORBIDITY About 20% have co-morbidity Medical Evaluation Hx: 3 generation pedigree, development, growth charts, regression, seizures, cognitive and behavioral function. PE: Hearing, vision, dysmorphia, gait, tremor, skin with Woods Lamp. CO-MORBIDITY $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ Labs?: genetic testing. ti Aprox 10 to 20% positive. Determine after discussion/ consult with geneticist. Metabolic and Mitochondrial testing. If indicated. CO-MORBIDITY Neuroimaging: 1. EEG is abnormal up to 70% of kids with ASD prior to seizure. 2. MRI if indicated Pica? think lead and ferritin levels 3

5 Nutrition complicated: Sensory assault/ compulsions/ rigidity/ rituals/emesis-gagging-rumination /pica GE reflux/ dental pain/ oral dysfunction/ lactose intolerance /constipation Behavioral arena, this is the Coliseum. GI problems: occur in 45 to 85% of kids? Upper to lower tract. Major reason for CAM Same vulnerability to traditional GI disorders as typical peers. Sutterella recently identified in ileum of children with autism and inflammatory bowel disease but absent in normal controls. Seizures and Epilepsy: occurs in 25% kids? Epilepsy defined as 2 or more unprovoked seizures of any type. Occur in 2 peaks: Some before 5ys. Most after 10, during puberty. Same approach to dx and tx as peers. 4

6 Sleep Disorders: occur in 50 to 80% of kids. With ASD these are more severe, chronic and challenging to manage. All components of sleep can be impaired, prolonged sleep onset, sleep maintenance, sleep phases. Sleep Disorders: Increased number of complicating factors in this population. Tx suggestions: 1. Assess for safety 2. Sleep hygiene, with behavioral component 3. meds. None FDA approved Sensory Differences: Sensory challenges are addressed in DSM-5 as part of autism. There is no universally accepted research evidence and little empirical evidence for the existence of SID, SPD/SMD and no plan to put in the DSM. Parents may murder you over this.. 5

7 Profile of disability in ASD Disruption/aggression 15-64% Self-injurious 8-38% Eating/guts 45 to 80% Sleeping 45-85% Toileting 40% Seizures 25% Treatment options CAM 1.Nutritional supplements 2.Diet therapy 3.Invasive therapies: IV immunoglobins, chelation, anti-viral, anti-biotic anti-fungal 4.Hyperbaric O2 Treatment options ABA Applied Behavior Analysis: behavior is learned response to environment. Behaviors can be reinforced, or negatively reinforced. B.F.Skinner Ivar Lovaas explosion of research, methods, subtypes 6

8 Treatment options Brain Changes from Behavioral Interventions This was the first trial to demonstrate that early behavioral intervention is associated with normalized patterns of brain activity, which is associated with improvements in social behavior, in young children with autism spectrum disorder. Dawson, et al. (2012). Early Behavioral Intervention Is Associated With Normalized Brain Activity in Young Children With Autism. Journal of the American Academy of Child & Adolescent Psychiatry, 51(11), Treatment options Occupational therapy: Speech therapy: Education: Treatment options Pharmacology: No Rx for autism. Meds used to manage symptoms. Irritability: Risperidone (Risperdal) and Aripiprazole (Abilify) FDA approved for children over 6. Sxs often benefited from Rx: Anxiety, Aggression, Self-Injury, Hyperactivity, OCD, Rigidity, Sleep dysfunction, Depression, Bipolar phenotype 7

9 Adult Service System Transition process: Michigan age 16 to 26 still served by schools. After age 18 may qualify for services from: CMH, Social Security, DHS home health supports MRS The Future? Adult Service System Overall quality of life for adults with disability correlates with ability to be employed. Employment success correlates with degree of immersion in main stream culture. 8

10 Engagement in education, employment, or training after leaving school Other health impairment Learning disability Speech / language impairment Hearing impairment Emotional disturbance Traumatic brain injury Visual impairment Orthopedic impairment Mental impairment Multiple disabilities Autism NLTS2, Percentage Evidence based resources 1. Association for Science in Autism Treatment 2. National Autism Center home of the National StandardsProject t 3. OCALI 4. MIND Institute Research history Dr. Leo Kanner, 1940 s Johns Hopkins, Dr. Hans Asperger, 1940 s Austria, Dr. Ivar Lovas, Norwegian UCLS Dr. Brunno Bettleheim German University of Chicago. Dr. Bernard Rimland. DAN drs. Dr. Eric Schopler, Dr. Gary Mesibov, Dr. Catherine Lord UNC chappel hill TEEACH Dr. Fred Volkmar Yale Child Study Center 9