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Suryadi Susanto
Pediatric Department
Krida Wacana Christian University
Epidemiology
AD (20.6/10,000)
Pathology
Brain structure
At birth until 2mo
head circumference is normal or slightly smaller
than normal
6-14mo
abnormally rapid increase in head circumference
2-4yr increased brain volume
increased volume of the cerebellum, cerebrum,
and amygdala, and marked abnormal growth in
the frontal, temporal, cerebellar, and limbic
regions of the brain
Pathology
Early, accelerated brain growth during the 1st
several years abnormally slow or arrested
growth
areas of underdeveloped and abnormal
circuitry in parts of the brain
Intellectual functioning
Vary from mental retardation to superior intellectual
functioning in select areas (splinter skills, savant
behavior).
Awareness and Sensitivity
Heightened sensitivity:
visual scanning of hand and finger movements
mouthing of objects
rubbing of surfaces
Lowered sensitivity:
diminished responses to pain and lack of
startle responses to sudden loud noises reflect
lowered sensitivity to other stimuli
Diagnosis
Clinical examination
developmental level
c A lack of spontaneous seeking to share enjoyment,
interests, or achievements with other people (e.g.,
developmental level
3 Restricted repetitive and stereotyped patterns of
behavior, interests, and activities, as manifested by
at least one of the following:
a Encompassing preoccupation with one or more
stereotyped and restricted patterns of interest
that is abnormal either in intensity or focus
b Apparently inflexible adherence to specific,
nonfunctional routines or rituals
c Stereotyped and repetitive motor manners (e.g.,
hand or finger flapping or twisting, or complex
whole-body movements)
d
Persistent preoccupation with parts of objects
B Delays or abnormal functioning in at least one of the following
areas, with onset prior to age 3 years: (1) social interaction, (2)
language as used in social communication, or (3) symbolic or
imaginative play.
Cornerstones of Treatment
Educational interventions
Behavioral therapies
Habilitative therapies
Pharmacotherapy
increase the ability of persons with AD to benefit
from educational and other interventions and to
remain in less-restrictive environments
Common targets
associated comorbid conditions
problematic behaviors
Aggression
self-injurious behavior
hyperactivity
Inattention
anxiety
mood lability
SELECTED POTENTIAL MEDICATION OPTIONS FOR COMMON
TARGET SYMPTOMS OR COEXISTING DIAGNOSIS IN
CHILDREN WITH AUTISM SPECTRUM DISORDERS
Prognosis
Remain in adulthood
Problems with independent living, employment,
social relationships, and mental health
those with communication abilities can grow
up to live self-sufficient lives in the community
with employment
remain dependent on their family or require
placement in facilities outside the home
Delayed diagnosis can lead to a poorer outcome
Prognosis
Better prognosis
higher intelligence
functional speech
less-bizarre symptoms
Behavior
symptom profile for some children might
change as they grow older
risk of seizures or self-injurious behavior
becomes more common.