Autism spectrum disorder (Part 4) – We have a diagnosis…what’s next?

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Hardimon, M. Autism spectrum disorder (Part 4) – We have a diagnosis…what’s next?, Don't Forget the Bubbles, 2018. Available at:
http://doi.org/10.31440/DFTB.15458

After meeting with Charlie and his family multiple times and getting further history from his daycare, you determine that Charlie does indeed have autism. You remember that early intervention programs have been shown to improve overall outcome but aren’t sure where to start 

Investigations

Autism is a clinical diagnosis; medical investigations may be used to identify causal conditions or known complications/associations.

Audiological and vision evaluation

 Genetics: Microarray + Fragile X

 Baseline bloods:

  • FBC (associated anaemia with hyper-sensivity with foods)
  • Lead levels
  • Iron studies

EEG, MRI and metabolic studies are not recommended routinely although can be considered in subset populations. There is not high therapeutic yield for these tests.

 

Treatment

There are two features of therapy that are of utmost importance:

  1. Multidisciplinary (speech, occupational therapy +/- psychology)
  2. Early and timely interventions

Therapy supports the child best when it is available in multiple environments (home and school).

 

But what can I do as a doctor?

Nationwide, Australia is transitioning to National Disability Insurance Scheme which requires both the family and medical professional to advocate for the young person to ensure a financial package that will support the child in all domains that are affected including but not limited to:

  • Communication
  • Social skills
  • Hearing and Vision
  • Continence
  • Mobility aides

Other financial supports that the family may be eligible for include:

  • Chronic disease management plan
  • Better Access to Mental health care scheme (both of which can be re-submitted on an annual basis)
  • Carers allowance/payment
  • Healthcare card
  • Continence aids payment scheme/Medical aids subsidy scheme

The parents should be encouraged to notify the school in order to allow coordination of services within this environment as well as allow the development of an individualized education plan where appropriate.

 

What about medication?

Medication itself will not “treat” autism however may be utilised for the associated diagnoses or difficulties seen. “Common” medications that may be seen being used by children with autism include:

  • Melatonin – for treatment of sleep dysregulation
  • Risperidone – for treatment of aggression
  • Fluoxetine – for treatment of anxiety/repetitive behaviours and rigidity
  • Movicol/osmolax – treatment of constipation
  • Methylphenidate/dexamphetamine – treatment of concomitant ADHD

Medication is not required in all children and should be considered on a case-to-case basis.

 

Surveillance

Primary care provider should provide surveillance for:

  • Medical disorders eg. Seizures, anaemia
  • Developmental and mental health co-morbidities eg. Anxiety, depression, hyperactivity, aggression 
  • Sleep problems eg. Delayed onset, frequent waking, restlessness
  • Feeding and weight problems (under and overweight)  +/- pica
  • Constipation
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About 

Mary is an advanced trainee in General Paediatrics/Community and Developmental Paediatrics. Has called Townsville home for the last decade. Outside of work, she enjoys eating and Crossfit (one of 'those people'!)

Author: Mary Hardimon Mary is an advanced trainee in General Paediatrics/Community and Developmental Paediatrics. Has called Townsville home for the last decade. Outside of work, she enjoys eating and Crossfit (one of 'those people'!)

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