Autism physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(11 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Autism}}
{{Autism}}
*
* {{CMG}}
Please help WikiDoc by adding more content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
==Physical Examination==
Several diagnostic instruments are available. Two are commonly used in autism research: the [[Autism Diagnostic Interview-Revised]] (ADI-R) is a semistructured parent interview, and the [[Autism Diagnostic Observation Schedule]] (ADOS) uses observation and interaction with the child. The [[Childhood Autism Rating Scale]] (CARS) is used widely in clinical environments to assess severity of autism based on observation of children.
===Autism Diagnostic Observation Schedule===
The Autism Diagnostic Observation Schedule (ADOS) is a standardized [[Guideline (medical)|protocol]] created in 1989 for assessing social and communicative behavior associated with [[autism]]. The protocol consists of a series of structured and semi-structured tasks that involve social interaction between the examiner and examinee. The examiner observes the subject's behavior and assigns identified segments to predetermined observational categories. Categorized observations are subsequently combined to produce numerical scores. Research-determined cut-offs identify the likely presence of autism or related autism spectrum disorders, allowing a standardized assessment of autistic symptoms. The [[Autism Diagnostic Interview-Revised|ADI-R]], a companion instrument, is a structured interview conducted with the parents of the referred interview and covers the full developmental history of the referred individual.
The ADOS cannot be used for formal diagnosis with individuals who are [[Blindness|blind]] or [[Deafness|deaf]] or who have other serious sensory or motor disorders such as [[cerebral palsy]] or [[muscular dystrophy]].


{{CMG}};{{AE}}{{Akshun}}{{HK}}


==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Physical examination of patients with autism is usually remarkable for repetitive [[behavior]], [[dyspraxia]], [[Gait abnormality|abnormal gait]], and abnormality of [[Motor control|motor functions]]. The signs of autism are present since birth but initial signs are visible by the age of 6-12 months. Most of the clinical signs of autism are identified by three years of age.


OR
==Physical Examination==
Clinical signs of autism are present since birth but are generally visible by three years of age. The earliest noticeable signs of autism are [[Social communication disorder|lack of social communication]], language deficits and repetitive stereotyped [[behavior]]. However routine early screening helps in early identification of autism in infants and toddlers. Patients with autism should also undergo observational assessment studies such as Autism Diagnostic Observational Schedule (ADOS). This observational schedule involves specific social situations and the child's response in these situations is noted. ADOS help determine patient's social communication skills and behavioral skills.In addition, patients with autism should be evaluated with full physical examination, especially general appearance and neurological exam with focus on child's [[affect]] in multiple settings (home, play group or school).<ref name="pmid17967920">{{cite journal |vauthors=Johnson CP, Myers SM |title=Identification and evaluation of children with autism spectrum disorders |journal=Pediatrics |volume=120 |issue=5 |pages=1183–215 |date=November 2007 |pmid=17967920 |doi=10.1542/peds.2007-2361 |url=}}</ref><ref name="pmid17048092">{{cite journal |vauthors=Lam KS, Aman MG |title=The Repetitive Behavior Scale-Revised: independent validation in individuals with autism spectrum disorders |journal=J Autism Dev Disord |volume=37 |issue=5 |pages=855–66 |date=May 2007 |pmid=17048092 |doi=10.1007/s10803-006-0213-z |url=}}</ref>
* Physical examination of patients with autism is usually remarkable for repetitive [[behavior]], [[dyspraxia]], [[Gait abnormality|abnormal gait]], and abnormality of [[Motor control|motor functions]].


Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
===Appearance of the Patient===
*Patients with autism usually appear [[anxious]]/irritated with repetitive [[behavior]].  


OR
===Skin===
Skin examination of patients with autism may show signs of [[injury]], if the patients depicts self mutilating behavior such as self biting, lip chewing, removal of hair or body punching. The signs include:
* [[Bruises]]
* [[Contusion]]
* Cuts


The presence of [finding(s)] on physical examination is diagnostic of [disease name].
=== Cognitive ===
Cognition should be assessed via the following scales:
* Bayley Scales of Infant Development
* Mullen Scales of Early Learning
* Wechsler Preschool and Primary Test of Intelligence
* Wechsler Intelligence Scale for Children
* Stanford-Binet Intelligence Scales


OR
=== Speech and Communication ===
* Preschool Language Scale
* MacArthur Communicative Development Inventory


The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
=== Motor ===
* Peabody Developmental Motor Scales
* Gross Motor Scale


==Physical Examination==
=== Adaptive ===
Clinical signs of autism are present since birth but are generally visible by three years of age. The earliest noticeable signs of autism are lack of social communication and language deficits. However routine early screening helps in early identification of autism in infants and toddlers.
* Vineland Adaptive Behavior Scales
* Physical examination of patients with autism is usually remarkable for repetitive behavior, dyspraxia, abnormal gait, and abnormality of motor functions.
* In addition, patients with autism should be evaluated with full physical examination, especially general appearance and neurological exam with focus on child's affect in multiple settings (home, play group or school).
* Patients with autism should also undergo observational assessment studies such as Autism Diagnostic Observational Schedule (ADOS). This observational schedule involves specific social situations and the child's response in these situations is noted. ADOS help determine patient's social communication skills and behavioral skills.


===Appearance of the Patient===
* Sensory profile
*Patients with autism usually appear anxious with repetitive behavior.
 
===Skin===
Skin examination of patients with autism may show signs of injury, if the patients depicts self mutilating behavior such as self biting, lip chewing, removal of hair or body punching. The signs include:
* Bruises
* Contusion
* Cuts


===HEENT===
===HEENT===
* I'''ncreased head circumference (may return ti normal in adolescence)'''
* Increased head circumference (may return to normal in [[adolescence]])<ref name="pmid12865374">{{cite journal |vauthors=Courchesne E, Carper R, Akshoomoff N |title=Evidence of brain overgrowth in the first year of life in autism |journal=JAMA |volume=290 |issue=3 |pages=337–44 |date=July 2003 |pmid=12865374 |doi=10.1001/jama.290.3.337 |url=}}</ref><ref name="pmid12136053">{{cite journal |vauthors=Aylward EH, Minshew NJ, Field K, Sparks BF, Singh N |title=Effects of age on brain volume and head circumference in autism |journal=Neurology |volume=59 |issue=2 |pages=175–83 |date=July 2002 |pmid=12136053 |doi= |url=}}</ref>
* '''Evidence of trauma'''
* Evidence of [[trauma]]
* '''Lack of eye contact'''
* Lack of eye contact
* '''Extra-ocular movements may be abnormal with unable to fix  gaze'''
* [[Extraocular muscles|Extra-ocular]] movements may be abnormal with unable to fix  gaze  
*'''Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation'''
*Ophthalmic exam may be abnormal with findings of [[retinal detachment]]
*'''Ophthalmic exam may be abnormal with findings of retinal detachment'''
*Delayed [[Verbal behavior|verbal]] and non-verbal communication
*'''Delayed verbal and non-verbal communication'''
*Lack of joint attention
===Neck===
===Neck===
* Neck examination of patients with autism is usually normal.
* Neck examination of patients with autism is usually normal.
Line 60: Line 57:


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* [[Tic|Motor tics]]
 
* Motor delay
* '''Motor tics'''
* [[Mental retardation]] (uncommon)
* '''Motor delay'''
* Atypical language with [[pronoun reversal]], use of non-sense words, [[echolalia]] or stereotyped phrases<ref name="pmid20889652">{{cite journal |vauthors=Constantino JN, Zhang Y, Frazier T, Abbacchi AM, Law P |title=Sibling recurrence and the genetic epidemiology of autism |journal=Am J Psychiatry |volume=167 |issue=11 |pages=1349–56 |date=November 2010 |pmid=20889652 |pmc=2970737 |doi=10.1176/appi.ajp.2010.09101470 |url=}}</ref>
* '''Mental retardation'''
* [[Aprosody]]
* Atypical language with pronoun reversal, use of non-sense words, echolalia or stereotyped phrases
* Aprosody
 
*Patient is usually oriented to persons, place, and time


===Extremities===
===Extremities===
Extremities examination of patients with autism may show hyperkinesia such as:
Extremities examination of patients with autism may show stereotypies and [[hyperkinesia]] such as:
* Hand flapping with a flaccid wrist; iIt is generally seen when the child is excited.
* Hand flapping with a [[flaccid]] wrist; it is generally seen when the child is excited.
* Other movements include bouncing up and down or rotating around an imaginary vertical axis.
* Other movements include bouncing up and down or rotating around an imaginary vertical axis.
* Abnormal palmar crease.
* Abnormal palmar crease
* Unusual [[posture]]


==References==
==References==

Latest revision as of 14:38, 2 April 2018

Autism Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Autism from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Behavioral Therapy

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Autism physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Autism physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Autism physical examination

CDC on Autism physical examination

Autism physical examination in the news

Blogs on Autism physical examination

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Autism physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]Syed Hassan A. Kazmi BSc, MD [3]

Overview

Physical examination of patients with autism is usually remarkable for repetitive behavior, dyspraxia, abnormal gait, and abnormality of motor functions. The signs of autism are present since birth but initial signs are visible by the age of 6-12 months. Most of the clinical signs of autism are identified by three years of age.

Physical Examination

Clinical signs of autism are present since birth but are generally visible by three years of age. The earliest noticeable signs of autism are lack of social communication, language deficits and repetitive stereotyped behavior. However routine early screening helps in early identification of autism in infants and toddlers. Patients with autism should also undergo observational assessment studies such as Autism Diagnostic Observational Schedule (ADOS). This observational schedule involves specific social situations and the child's response in these situations is noted. ADOS help determine patient's social communication skills and behavioral skills.In addition, patients with autism should be evaluated with full physical examination, especially general appearance and neurological exam with focus on child's affect in multiple settings (home, play group or school).[1][2]

Appearance of the Patient

  • Patients with autism usually appear anxious/irritated with repetitive behavior.

Skin

Skin examination of patients with autism may show signs of injury, if the patients depicts self mutilating behavior such as self biting, lip chewing, removal of hair or body punching. The signs include:

Cognitive

Cognition should be assessed via the following scales:

  • Bayley Scales of Infant Development
  • Mullen Scales of Early Learning
  • Wechsler Preschool and Primary Test of Intelligence
  • Wechsler Intelligence Scale for Children
  • Stanford-Binet Intelligence Scales

Speech and Communication

  • Preschool Language Scale
  • MacArthur Communicative Development Inventory

Motor

  • Peabody Developmental Motor Scales
  • Gross Motor Scale

Adaptive

  • Vineland Adaptive Behavior Scales
  • Sensory profile

HEENT

  • Increased head circumference (may return to normal in adolescence)[3][4]
  • Evidence of trauma
  • Lack of eye contact
  • Extra-ocular movements may be abnormal with unable to fix gaze
  • Ophthalmic exam may be abnormal with findings of retinal detachment
  • Delayed verbal and non-verbal communication
  • Lack of joint attention

Neck

  • Neck examination of patients with autism is usually normal.

Heart

  • Cardiovascular examination of patients with autism is usually normal.

Abdomen

Abdominal examination of patients with autism is usually normal.

Neuromuscular

Extremities

Extremities examination of patients with autism may show stereotypies and hyperkinesia such as:

  • Hand flapping with a flaccid wrist; it is generally seen when the child is excited.
  • Other movements include bouncing up and down or rotating around an imaginary vertical axis.
  • Abnormal palmar crease
  • Unusual posture

References

  1. ↑ Johnson CP, Myers SM (November 2007). "Identification and evaluation of children with autism spectrum disorders". Pediatrics. 120 (5): 1183–215. doi:10.1542/peds.2007-2361. PMID 17967920.
  2. ↑ Lam KS, Aman MG (May 2007). "The Repetitive Behavior Scale-Revised: independent validation in individuals with autism spectrum disorders". J Autism Dev Disord. 37 (5): 855–66. doi:10.1007/s10803-006-0213-z. PMID 17048092.
  3. ↑ Courchesne E, Carper R, Akshoomoff N (July 2003). "Evidence of brain overgrowth in the first year of life in autism". JAMA. 290 (3): 337–44. doi:10.1001/jama.290.3.337. PMID 12865374.
  4. ↑ Aylward EH, Minshew NJ, Field K, Sparks BF, Singh N (July 2002). "Effects of age on brain volume and head circumference in autism". Neurology. 59 (2): 175–83. PMID 12136053.
  5. ↑ Constantino JN, Zhang Y, Frazier T, Abbacchi AM, Law P (November 2010). "Sibling recurrence and the genetic epidemiology of autism". Am J Psychiatry. 167 (11): 1349–56. doi:10.1176/appi.ajp.2010.09101470. PMC 2970737. PMID 20889652.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Autism_physical_examination&oldid=1458432"