Autism

Epidemiology

• Male:Female 1:4

• Incidence 1/00

• 5-10% have seizures

Aetiology

• 70% heritability

• Many froms of genetic variation and modes of inheritance

o De novo mutations, autosomal recessive, autosomal dominant, x-linked (fragile x, DMD), additive (polygenic) risk

• With current genetic techniques a cause can be found in ~20% of cases

Defining features:

Defined by triad of:

• Social communication impairment

• Impairment in socialisations and interactions

• Repetitive, restrictive behaviours

(N.B. DSM V has collapsed first two criteria together into one)

Other

• Sensory seeking and sensory avoidant behaviour

• Lack of ability to understand other people perspective (theory of mind disorder)

Clinical Issues:

• Anxiety

• Mood extremes – very rapid transition and difficulty winding down

• Poor sleep

o Trial melatonin

o White noise

o Weighted blanket

o Massage

• Difficulty shifting attention

• Need preparation/warning to transition to new task

Treatment

• Antipsychotics

• Risperidone approved (3-4mg nocte in adults)

• Aripiprazole has some minor evidence, not PBS listed in Australia

• Olanzapine and haloperidol can be used but worse side effects

• SSRI’s may be helpful in some cases

o Fluoxetine and sertraline

o Anxiety high dose, depression low dose

o Citalopram not useful

o TCA’a – overdose potential

• AEDs not helpful for mood issues in general

• Sleep

o 3-10mg of melatonin at night 2 hours before bed

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