Autism

Casebank History
1

Who are you:
You are an FY2 in GP surgery.

Who the patient is:
Mother of Jason, 3 years old, is concerned.

What you should do:
Talk to her and address her concerns.

Signs of autism in young children include:

  • Not responding to their name.
  • Avoiding eye contact.
  • Not smiling when you smile at them.
  • Getting very upset if they do not like a certain taste, smell, or sound.
  • Repetitive movements, such as flapping their hands, flicking their fingers or rocking their body.
  • Not talking as much as other children and repeating the same phrases.

P1 (odipara)
First confirm identity, name of child, relationship to child and child’s D.O.B.
Doctor: How can I help you?
Patient: My 3-year-old son is still not speaking.
D: Can you tell me more about it?
P: I don’t know the age when kids should talk, but I think this is not normal. Also, he is sits alone all day and he doesn’t interact with people.
D: Does he say any words at all?
P: No, he just makes sounds.
D: When did you notice that?
P: When he started kindergarten, I started to notice that he is different from the other kids.
D: When you call him does he respond to you?
P: I think he hears me, but he doesn’t respond.
D: Does he make any eye contact?
P: He does but he can’t maintain eye contact.
D: Have you noticed any repetitive behaviour?
P: Yes, all the time, he is always flipping his hands.
D: Does he do that at specific times throughout the day, or randomly?
P: I don’t know, it seems random.
D: Does he share his toys?
P: No.
D: Does he like to place his toys in a straight line?
P: Yes! He does that a lot.
D: Apart from these things, is there anything else?
P: No.

DDs:
Normal head to toe.
D: Any fever?
P: No.
D: Any rash on his body?
P: No.

P2
D: Has he ever had any delays in his development in the past?
P: No.
D: Has he been diagnosed with any medical condition?
P: No.

BIRD DDD
Birth is important
D: Was he born preterm or full-term?
P: Full term
D: Any problem during pregnancy?
P: No.
D: What about during delivery?
P: No.
Dehydration
D: Is he active and playful?
P: Yes
D: Is he going for a wee as usual?
P: Yes
D: Is he drowsy or floppy?
P: No.
DIET:
D: Are you satisfied with his diet?
P: Yes.
D: Is he feeding well?
P: Yes.
NAI
D: Who do you live with other than Jason?
P: My husband and his 4-year-old brother.
D: Is your husband Jason’s dad?
P: Yes.
D: Is everything OK at home?
P: Yes, we are great.
Other development
D: Are you happy with the other aspects of his development?
P: Yes, he is well developed otherwise.
D: Any problems with walking?
P: No.

MAF
D: Any medication including OTC medicines?
P: No.
D: Any allergies?
P: No.
D: Any family history of delayed speech?
P: Well, my niece has autism and she had delayed speech.

Examination:
Head to toe examination.
Provisional Dx:
OK, so from the things you have told me about Jason, it sounds like he may have autism. However, it’s not possible for me to give you a definite diagnosis right now, for a definite diagnosis I would have to refer him to a team of autism specialists. They would assess him over a period of time before confirming it is autism.

  • Being autistic does not mean you have an illness or disease. It means your brain works in a different way from other people.
  • It’s something you’re born with or first appears when you’re very young.
  • If you’re autistic, you’re autistic your whole life.
  • Autism is not a medical condition with treatments or a “cure”. But some people need support to help them with certain things.
  • Don’t think of this as a problem that needs fixing, instead accept that this is the way your child is and try to understand all aspects of his personality.

Autistic people may:

  • Find it hard to communicate and interact with other people.
  • Find it hard to understand how other people think or feel.
  • Find things like bright lights or loud noises overwhelming, stressful or uncomfortable.
  • Get anxious or upset about unfamiliar situations and social events.
  • Take longer to understand information.
  • Do or think the same things repeatedly.

Management:
I will talk to my senior as:

  • We will need a 6-month assessment.
  • We will refer him to a specialist (Autism team or health care professional).
  • The specialist will make a more in-depth assessment which should be started within 3 months of referral with MDT which will include:
    – Language therapist
    – Behavioural therapist
    – Occupational therapist
    – Psychologist
  • School will need some guidance.

Any concerns??
Q: Does he have this because of the MMR vaccine?
A: Well, there have been rumours on the internet that the MMR vaccine was causing autism, because autism is usually diagnosed at around the same age that MMR vaccine was given. So, a small number of people linked the two together and concluded falsely that the MMR vaccine was causing autism. HOWEVER, this theory has long since been refuted by many doctors and studies.
Q: Why does he have this then?
The exact cause is unknown; however, it could be caused by:

  • Genetics: Many researchers found that Autism is known to run in families.
  • Environmental triggers:
    – Being premature child before 35 weeks.
    – Being exposed to alcohol in womb.
    – Being exposed to certain medicine (Na valproate) in the womb.
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