MHM Magazine

Issue 5 | 2021 | MENTALHEALTHMATTERS | 17 MHM play with him. His lack of educational progress was due to ongoing tantrums triggered by his inability to change focus and comply with commands. He was irritable and sensitive to food textures and loud noises, affecting his routine care such as haircuts and dental check-ups. The diagnosis of autism spectrum disorder (ASD) was made, without accompanying intellectual impairment and with language impairment (phrase speech). It was noted that he required substantial support for shortfalls in social communication and restricted, repetitive behaviours. A trial of risperidone medication was initiated for treatment of his stubbornness and irritability. His tantrums decreased dramatically, and he was more responsive to the school curriculum. DSM-5 FEATURES FOR ASD: A: Shortfalls in social communication and interaction as illustrated currently or by history: • Problems in forming shared relationships due to a lack of social-emotional exchange such as sharing interests, limited conversation, and restricted social engagement. • Limited nonverbal communication (body language) such as lack of eye contact, confined social gestures, and absent facial expressions. • Problems in developing and maintaining relationships such as lack of flexibility, problems adapting to situations and change, difficulties in sharing, lack of imaginative play, and troubles in friendships. B: Limited- and uninteresting patterns of behaviour, interests and activities as illustrated currently or by history: • Aimless and repetitive motor movements or speech, such as lining up toys, flipping objects, echolalia (meaningless repetition of another person’s speech), repetitive phrases. • Insistence on sameness reflected by inflexible routines, ritualised patterns, rigid thinking • Limited, fixed, and intense interests: preoccupation with objects or topics. • Hyper or hypo-reactive response to sensory input expressed by sensitivity to sound/textures, excessive smelling/touching of objects. Specifying the current severity is based on the level of support needed for each of the two psychopathological areas (A&B) e.g., A. Social communication impairments and B. Restricted, repetitive patterns of behaviour • Level 3: “Requiring very substantial support” • Level 2: “Requiring substantial support” • Level 1: “Requiring support” Other measures include: C: Symptoms begin during early child development D: Symptoms cause significant loss in functioning E: The disturbance is not better explained by an intellectual disability (mental impairment) or global developmental delay ( extensive child-developmental disruption). It is common for ASD to co-occur with intellectual disability. Specify if: • With or without accompanying intellectual impairment • With or without accompanying language impairment • Associated with a known medical or genetic condition or environmental factor • Associated with another neurodevelopmental, mental, or behavioural disorder • With catatonia Comorbidity of neurodevelopmental disorders: These disorders often co-occur with other neurodevelopmental disorders and/ or may occur with other psychiatric disorders (anxiety disorders) and/or other medical conditions (epilepsy). This may complicate prognosis and treatment. Early detection of ASD with immediate intervention improves the prognosis. ROLE OF THE GENERAL PRACTITIONER (GP) IN THE MANAGEMENT AND TREATMENT OF ASD: A. Psychoeducation: • Reported incidences for ASD are approaching 1% of the population. • ASD is diagnosed four times more frequently in males than females. • A positive outcome for ASD depends on the absence of associated intellectual disability, language impairment and additional mental health problems. • Age of onset is typically 12-24 months of age but maybe earlier than 12 months. • A small number of complex cases with clear dramatic loss of words or skills are included under DSM-IV childhood disintegrative disorders, showing the worst prognosis. B. Early symptom identification and screening • Physical, psychiatric, and neurological examinations to exclude other medical conditions, including eye tests and a hearing evaluation. • Side room and blood tests, special investigations such as the Electroencephalogram (EEG) and/or Brain-/MRI scan, referral to a paediatrician or neuro- paediatrician, if indicated. • Referral to a qualified child and adolescent professional mental health care practitioner and/or