highly progressive intellectual disability in children worldwide. challengers are miss diagnosis .

1. Gayani Liyanage -8D1

2. Outline
• What is autism ?
• Classification system
• Autistic spectrum disorder
• Diagnosis
• Treatment
• Challenges in Srilanka

3. What is Autism ?
Early childhood is a time of rapid brain growth and development.
However certain genetic and environment factors may cause brain
development delay.
These may cause communication difficulties ,social behavioral
challenges which may manifest in spectrum of disorder known as
autism .

4. Autism is …..
The characteristic type of abnormal functions in all the 3 areas of ,
 Social interaction
 Communication
 Restricted ,stereotyped repetitive behavior
(DSM-IV )
It is most pervasive development disorder.
Symptoms are typically recognized between one and two years of
age.(before 3 year )
Common in male than female 4:1 ratio .

5. Fist describe by psychiatrist “Leo Kanner” in 1943 in the US.
Leo Kanner was an Austrian-American psychiatrist, physician, and
social activist best known for his work related to autism. Before
working at the Henry Phipps Psychiatric Clinic at Johns Hopkins
Hospital in Baltimore, Maryland, Kanner practiced as a physician
in Germany and in South Dakota. In 1943, Kanner published his
landmark paper, "Autistic Disturbances of Affective Contact,"
describing 11 children who were highly intelligent but displayed
"a powerful desire for aloneness" and "an obsessive insistence on
persistent sameness.

6. According to world health organization by year 2020 children with
neurodevelopment disorder will raise by over 50% internationally .
Study in USA review 1 in 68 children affected by autism .
In Srilanka according to study conducted in urban Colombo 1 in 93
children are born with autism .

7. Classification system
There are 5 diagnostic categories
 Autistic disorder
 Asperger‘s syndrome
 Rett’s syndrome
 Childhood disintegrative disorder
 Pervasive developmental disorder not otherwise specified
(Atypical autism)
(DSM-IV,ICD-10)

8. The word Autisitic Spectrum Disorder ( ASD ) is widely used to describe
all of the condition .

9. Autistic disorder
Characters /Symptoms
1) Social deficits
 Reduced eye contact
 Unusual facial expression
 Lack of gesture
 Lack of empathy
 Few peer relationship
 Does not respond to affection

10.  Poor understanding about others feelings
 May not value the company of their parents
02) Communication deficit
 Speech may completely absent- 30%
 Common abnormalities in speech include
• Repetition of speech
• Unusual pitch ,stress ,rhythm
• Pronoun reversal
 Difficulty in two way conversation

11. 03) Restricted repetitive interests and behavior
 Strange attachment to unusual objectives
 Spend majority of time with them and rejecting other toys
 Stereotypies – Hand flapping or head rolling
 Routines of behavior and inevitable show restriction to change

12. Asperger‘s syndrome
• Children with Asperger’s has characteristic impairment in social
interaction and repetitive behaviors or restricted interest that are
seen in autism but they have normal speech and intellectual abilities .
• Doesn’t become obvious until around 4-8 years (cause social
interaction and behaviors become relevant around this age )
• They have unusual deep interest in one particular topic and perform
at a high level in one particular activity

13. • Mood disorder and anxiety disorder seen in 65% od Asperger’s by
adulthood
• Majority of them attend main stream school with extra classroom
support but may be subjected to bulling due to their social
eccentricity

14. Rett’s syndrome
• Development disorder of the female and shows many characteristic
features of autism
• Cause due to mutation in MECP-2 gene on x-chromosome
• Develop in 6-18 month
• They loss speech ,motor skill , head growth, purposeful hand
movement
• Presented with physical problems (80%) ,constipation ,poor growth
,scoliosis ,cardiac and motor problems
• Average life expectancy 30 years

15. Childhood disintegrative disorder
• Shows normal development over first 2 years followed by marked
regression and loss of skill in multiple areas of development over few
month
• Present with difficulty in social skill ,communicating skill and
repetitive restricted interest and behavior
• Majority have sever form of epilepsy
• Functioning remain extremely low and individual never independent

16. Pervasive developmental disorder not otherwise
specified (Atypical autism)
• Children who do not quite meet the diagnostic criteria for a specific
neurodevelopment disorder but shows many of characteristic typical
of them

17. Diagnosis
Currently there is no specific medical test or diagnostic method to
identify autism.
Hence diagnosis is made on clinical observation and evaluation
involving multi disciplinary team including,
• Child psychiatrist
• Pediatrician
• Neurologist
• Phycologist
• Speech and language therapist
• Occupational therapist

18. From the birth differences or delay of
• child communication
• Social interaction
• Behavioral differences
Could be the primary observation in identification autism.
Ex: not response to stimuli such as smiling ,speech, facial expression ,cry
while holding, poor eye contact, over or under stimulation to sound.
Usually first notice by parents.
These development changes can be observed 1-2 years of their life .some of
them such as different social interaction may manifest lateron.

19. Treatment (General, biological ,psychological)
General
Treatment for children with autism require great responsibility and
care.
Treatment done by multidisciplinary team, not only medical team but
the involvement of parents ,family, teachers, different institute is
needed to help children with this condition .
To prevent the condition public awareness is important ,cause early
identification of condition minimize the effect of disease and treatment
give rise to good result.

20. These children’s communication skill, play skill , physical activities
social interactions and language skill play a important roll and daily and
regular interaction of these children with other children in educational
and other activities result better outcome .
So under general treatment option basically care about the children’s
• Psychoeducation
• Appropriate educational settings
• Psychiatric and physical co-morbidities
• Parental training

21. Biological
• Atypical antipsychotic (risperidone)- effective in reducing aggression ,
irritability, anxiety, stereotypies .
• Stimulants or Atomoxetine – effective in children with comorbid
ADHD (Attention Difficulties and Hyperactive Disorders)
• SSRI-reduce repetitive or obsessive behaviors

22. Psychological treatment
Behavioural training programmes
Aim is to reduce antisocial or troublesome behaviours
Ex-
 Speech and language therapy
 Social skill training
 Behavioural modification programmes

23. Course and prognosis
• 2/3 acquired some useful speech.
• Serious impairment usually remain.
• Abnormal behavior continue in to adulthood but become less social
impairing with time.
• Only about 10-20 % of children are able to attend a main stream
school (with normal IQ)

24. Challenges in Srilanka
 General Medical Officers (GMOs) in Sri Lanka, who are often the first
point of contact for families, may not be aware of the characteristics
of ASD and may be unsure how to advice parents or may dismiss their
concerns regarding their children. Therefore, families that are able. to
afford, seek help to obtain a diagnosis elsewhere, spending valuable
time and financial resources to travel to other more developed
countries.
Very few schools accepted children with ASD even the school did
that accept limited number per year.
Lack of adult service and employment opportunities.

25. There is a general lack of awareness among Sri Lankan society
regarding people with disabilities, especially those with ASD. There is
deep-seated stigma associated with disability in this country. This
stigma often makes people unwilling to even admit they have a family
member with a disability. Children and adults with ASD may not be
taken out in public for fear of embarrassment and shame from
society.

26. Thank you !