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Comorbid Disorder in Autism

Comorbid Disorder in Autism. Tom Berney Northgate & Prudhoe NHS Trust Fleming Nuffield Child & Family Psychiatry Unit European Services for People with Autism (ESPA). Athens University visit. Comorbid Disorder in Autism. Concepts Autism Symptoms, syndrome & disorder

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Comorbid Disorder in Autism

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  1. Comorbid Disorder in Autism Tom Berney Northgate & Prudhoe NHS Trust Fleming Nuffield Child & Family Psychiatry Unit European Services for People with Autism (ESPA) Athens University visit

  2. Comorbid Disorder in Autism • Concepts • Autism • Symptoms, syndrome & disorder • Developmental disabilities • Attention deficit & hyperactivity • Tics • Obsessions & compulsions • Comorbid conditions • Epilepsy • Schizophrenia • Arousal (anxiety / aggression)

  3. Comorbid Disorder in Autism • Concepts • Autism • Symptoms, syndrome & disorder • Developmental disabilities • Attention deficit & hyperactivity • Tics • Obsessions & compulsions • Comorbid conditions • Epilepsy • Schizophrenia • Arousal (anxiety / aggression)

  4. symptoms symptoms Syndrome Disorder genetic cause symptoms Circumscribed interests OCD Repetitive/stereotyped movements Autism What is ‘autism’ Social responsiveness Communication Autism as a syndrome 2o to a medical disorder Autism as a 1o disorder Limited imagination / creativity

  5. disorder syndrome Autism What is ‘autism’ Primary Genetic disorder - interaction of 3+ sites • Secondary • to any disorder that causes LD • tuberous sclerosis • fragile X

  6. Theory of Mind Executive Function Empathy Voluntary Automatic Circumscribed interests OCD Repetitive/stereotyped movements Autism Diagnostic domains Social responsiveness Communication Limited imagination / creativity

  7. Social responsiveness Communication Theory of Mind Executive Function Empathy Voluntary Automatic Motor abnormality Perception Co-ordination Central coherence Bowel dysfunction Immunology Tone Circumscribed interests OCD Epilepsy Repetitive/stereotyped movements Depression Autism Pervasive & complex disorder Socialresponsiveness

  8. Research Clinical Administrative Threshold of diagnosis Autism The purpose of the diagnosis

  9. ASD Neurotypical Threshold of diagnosis Autism A syndromal (> a laboratory) diagnosis • A continuum, • the diagnostic threshold depending on: • the autism - how severe / fragile • sympathy of the setting Autism Asperger’s Broader phenotype

  10. Subtypes – depend on: • level of cognitive ability • change with age • Aloof • Passive • Active-but-odd Threshold of diagnosis Autism A syndromal (> a laboratory) diagnosis • A continuum, • the diagnostic threshold depending on: • the autism - how severe / fragile • sympathy of the setting

  11. Developmental disorders • Disorders that are: • innate (genetic) • change with development(i.e. brought out at different ages)

  12. OCD ADHD ASD Tics Age (yrs) 0 5 10 15 20 Developmental trajectories Developmental disorders

  13. Specific developmental disabilities Symptoms

  14. Specific developmental disabilities AD Dyscalculia Hyperactivity Language problems Impulsivity Dyslexia Social impairment Obsessions & Compulsions Stereotypy Repetitive self stimn Tics Dyspraxia Catatonic symptoms

  15. Developmental syndromes AD Dyscalculia Hyperactivity language problems Impulsivity Dyslexia Social impairment Obsessions & Compulsions Stereotypy Repetitive self stimn Tics Dyspraxia Catatonic symptoms

  16. ADHD Hybrid disorder Autism (Autism-ADHD) Comorbid disorders Developmental disorders

  17. 2o autism 1o autism Concepts Symptoms arousal (anxiety / aggression) inattention depression obsessions tics Syndromes ADHD OCD Tourette Disorders Epilepsy Schizophrenia Cyclical disorders

  18. Comorbid Disorder in Autism • Concepts • Autism • Symptoms, syndrome & disorder • Developmental disabilities • Attention deficit & hyperactivity • Tics • Obsessions & compulsions • Comorbid conditions • Epilepsy • Schizophrenia • Arousal (anxiety / aggression)

  19. Comorbid Disorder in Autism • Concepts • Autism • Symptoms, syndrome & disorder • Developmental disabilities • Attention deficit & hyperactivity • Tics • Obsessions & compulsions • Comorbid conditions • Epilepsy • Schizophrenia • Arousal (anxiety / aggression)

  20. ASD in epilepsy Epilepsy (seizures) in ASD (5-30%) Depends on degree & nature of disability Selected populations • About 5-10% in childhood Asperger Disability - more severe / multiple • Up to 70% in disintegrative disorder Cause of autism - 10 & 20 Bimodal onset - childhood & adolescence Diagnosis - how narrow / broad Comorbid disorder Epilepsy Regression (probably) unrelated to epilepsy

  21. Epilepsy can amplify the symptoms of autism Repetitive & stereotyped behaviours Social impairment Repetitive & stereotyped behaviours Social impairment Communication abnormality Communication abnormality Comorbid disorder Epilepsy

  22. Comorbid disorder Epilepsy Can epilepsy mimic the symptoms of autism? Repetitive & stereotyped behaviours Social impairment Communication abnormality

  23. Comorbid Disorder in Autism • Concepts • Autism • Symptoms, syndrome & disorder • Developmental disabilities • Attention deficit & hyperactivity • Tics • Obsessions & compulsions • Comorbid conditions • Epilepsy • Schizophrenia • Arousal (anxiety / aggression)

  24. Comorbid disorder Schizophrenia • Positive Symptoms • Delusions • Hallucinations • Thought disorder • Abnormal movement • catatonia • stereotypies Psychosis • Negative Symptoms • Withdrawal (autism) • Emotional change • inappropriate • blunted / apathy

  25. Age Birth 16 yrs. Autism Autism Unitary psychosis Schizophrenia 1971 Comorbid disorder Schizophrenia Autism Asperger’s Broader phenotype - SD - Schizoid PD Schizophrenia

  26. Age Birth 16 yrs. Comorbid disorder Schizophrenia Developmental trajectories Autism Schizophrenia

  27. Age Birth 16 yrs. Comorbid disorder Schizophrenia Developmental trajectories Autism Schizophrenia Asperger

  28. Difficulty in expressing thoughts & feelings Pragmatic difficulty – irrelevant detail Reality ≈ observed fiction thought disorder High arousal hallucinations Catatonic symptomatology Impassivity • negativism • initiation • mutism Maintained in anxiety states Developmental trajectory Comorbid disorder Schizophrenia Why the confusion? Thoughts & Perceptions Motor Performance & Skills

  29. Not supported by outcome studies Similar underlying abnormalities How do we define schizophrenia • presenting symptomatology? • course & prognosis? Comorbid disorder Schizophrenia What is the relationship? Does Autism predispose to schizophrenia? Autism does not protect against schizophrenia

  30. Comorbid Disorder in Autism • Concepts • Autism • Symptoms, syndrome & disorder • Developmental disabilities • Attention deficit & hyperactivity • Tics • Obsessions & compulsions • Comorbid conditions • Epilepsy • Schizophrenia • Arousal (anxiety / aggression)

  31. events control Symptoms Emotional arousal Anxiety Uncertainty Obsessions Compulsions

  32. Fear Panic Symptoms Emotional arousal Anxiety Anger Sexual arousal Obsessions Compulsions

  33. verbal predatory / instrumental defensive / reactive pain property organic states frustration people emotional arousal communicative drugs others self Symptoms Aggression form function cause unusual perception brain injury epilepsy alcohol / stimulants / AEDs self-injury (SIB) self-stimulation

  34. Social reinforcement High pain threshold Compulsion Symptoms SIB self-stimulation SIB

  35. Autism symptoms Comorbid symptoms Maladaptive response Interaction → complex presentation

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