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Dr. Amit VatkarMBBS, DCH, DNB Pediatrics
Fellow in Pediatric Neurology, MumbaiTrained in Neurophysiology & Epilepsy, USA
Contact No. : +91-8767844488Email: [email protected]
AUTISM SPECTRUM DISORDER
What Is Autism? What is Autism Spectrum Disorder?
• Autism spectrum disorder/ Autism- general terms for a group of complex disorders of brain development
• Difficulties in social interaction
• Verbal and nonverbal communication
• Repetitive behaviours
• DSM-5 diagnostic manual, all autism disorder- one umbrella diagnosis of ASD
• Associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances
When does autism develop?
• Problems in very early brain development
• Symptoms of autism tend to emerge between 2 and 3 years of age
• Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism
• Between 14 and 24 months, the Early-ASD group exhibited greater delays in language development compared with the Later-ASD group
• 36 months, the Later-ASD group indicated impairments of comparable severity to the Early-ASD group
• Earlier or later diagnosis is not predictive of symptom severity
• ASD diagnosis did not correlate with a specific developmental pattern—either plateau of skills or regression
How Common Is Autism?
• Disease Control and Prevention (CDC) identify - 1 in 68 American children to be ASD
• A ten-fold increase in prevalence in 40 years
• Four to five times more common among boys than girls
• 1 out of 42 boys and 1 in 189 girls
What Causes Autism?
• “We have no idea.”
• Genetic cause in 10%–30% of people
• Fragile X syndrome (1%), Tuberous sclerosis (1%) or Rett syndrome (0.5%).
• Genetic predisposition to autism, a number of nongenetic, or “environmental,” stresses appear to further increase a child’s risk
• Advanced parental age at time of conception (both mom and dad)
• Maternal illness during pregnancy and certain difficulties during birth
• Oxygen deprivation to the baby’s brain
• Risk of having a child with autism by taking prenatal vitamins containing folic acid and/or eating a diet rich in folic acid
• High rates of gastrointestinal symptoms. GI distress is associated with more-severe autism symptoms including social withdrawal and irritability.
How to diagnose autism?
• Clinical diagnosis with signs and symptoms• Ages and Stages Questionnaire-II (ASQ-II)- 9-, 13-, and
30-month well-baby visits• Modified Checklist for Autism in Toddlers (M-CHAT)-
18- and 24-month visits• ASD is sometimes accompanied by one or more
comorbid health condition, such as gastrointestinal (GI) issues, seizures, sleep disorders and psychiatric disorders.
• Microbiota modulate behavioral and physiological abnormalities associated with neurodevelopmentaldisorders
What Does It Mean to Be “On the Spectrum”?
• Autism is unique
• Exceptional abilities in visual skills, music and academic skills
• 40 percent have average to above average intellectual abilities
• 25 percent of individuals with ASD are nonverbal but can learn to communicate using other means
What treatments and interventions are available, and are they effective?
Behavioural interventions• Improving language, cognitive and adaptive skills using
applied behaviour analysis (ABA) techniques• Early intensive ABA-based treatment (typically for 2–3 yr)
significantly enhances outcomes • Joint Attention Symbolic Play Engagement and Regulation
(JASPER), would improve social communication outcomes• Children with disabilities should receive a free public
education in the "least restrictive environment" (i.e., in a "regular classroom" with non-disabled peers).
• Speech, Occupational, and Physical therapies in addition to their weekly early intervention services.
Biomedical interventions• Irritability and impulsive aggression- Risperidone and Aripiprazole,
two atypical antipsychotic medications• Hyperactivity and inattention- Stimulants and Atomoxetine may be
effective for treating ADHD-like symptoms in patients with ASD• Repetitive behaviours- Risperidone and Aripiprazole significantly
reduced repetitive behaviours• Sleep disturbances- melatonin among patients with ASD is
associated with improved sleep parameters• Theoretical promise and deserve further research (e.g., omega-3
fatty acids, B complex vitamins, special diets), others are potentially harmful (e.g., chelation) or simply expensive and ineffective (e.g., secretin).
• Probiotic known to relieve gut inflammation also improved social behavior while reducing repetitive behaviors and signs of anxiety
Outcomes
• Small subset of children with autism entirely overcome their disabilities- Intensive early intervention and biological differences may have been crucial to their optimal outcomes
• low to modest levels of independence and/or social inclusion among both higher- and lower-functioning individuals.
• Core phenotypic features and challenging behaviours persist, although some problems can improve over time
• Some improved outcomes may be because of more inclusive and specialized educational programs
• The level of verbal communication and IQ before five years of age are the strongest predictors of outcome.
About Dr. Amit Vatkar
Dr. Amit Vatkar is a Pediatric Neurologist from Mumbai, India. He has completed his fellowship in Pediatric Neurology with specialising in Epilepsy surgery workup from Hinduja hospital under the guidance of Vrajesh Udani, top neurologist in India. He has also been trained in Epilepsy & neurophysiology at Case Western Reserve University at Cleveland under the guidance of Dr. Hans Luders.
He specialises in Clinical Neurophysiology (EEG, EMG and NCV). He also provides portable EEG services in Mumbai.
Currently, He is supporting many schools for children with special needs. He is attached to major hospitals in Mumbai where he consults pediatric neurological cases. His areas of expertise are
1. Epilepsy, Seizure disorders2. Developmental Disorders including delayed speech, motor milestones, and coordination issues3. Autism and other Behavioural disorders, including attention-deficit/hyperactivity disorder (ADHD), school failure and sleep problems4. Movement Disorders, 5. Cerebral palsy, muscular dystrophy, and nerve muscle disorders 6. Headaches, including migraines
Dr. Amit VatkarPediatric Neurologist, Navi Mumbai
MBBS, DNB
Email: [email protected] No.: +91-8767844488
Visit us at: http://pediatricneurology.in/
THANK YOU !
