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:
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
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 HardimonMary 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'!)
Autism spectrum disorder (Part 4) – We have a diagnosis…what’s next?
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:
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:
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:
Other financial supports that the family may be eligible for include:
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:
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:
About 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'!)