Autism physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Autism}} | {{Autism}} | ||
{{CMG}};{{AE}}{{Akshun}} | |||
{{CMG}};{{AE}}{{Akshun}}{{HK}} | |||
==Overview== | ==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 | 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. | ||
==Physical Examination== | ==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).<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> | 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, abnormal gait, and abnormality of motor functions. | * Physical examination of patients with autism is usually remarkable for repetitive [[behavior]], [[dyspraxia]], [[Gait abnormality|abnormal gait]], and abnormality of [[Motor control|motor functions]]. | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with autism usually appear anxious/irritated with repetitive behavior. | *Patients with autism usually appear [[anxious]]/irritated with repetitive [[behavior]]. | ||
===Skin=== | ===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: | 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 | * [[Bruises]] | ||
* Contusion | * [[Contusion]] | ||
* Cuts | * Cuts | ||
=== 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=== | ===HEENT=== | ||
* 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> | * 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 | ||
*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 | *Lack of joint attention | ||
===Neck=== | ===Neck=== | ||
| Line 36: | Line 57: | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Motor tics | * [[Tic|Motor tics]] | ||
* Motor delay | * Motor delay | ||
* Mental retardation (uncommon) | * [[Mental retardation]] (uncommon) | ||
* 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> | * 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> | ||
* Aprosody | * [[Aprosody]] | ||
===Extremities=== | ===Extremities=== | ||
Extremities examination of patients with autism may show stereotypies and hyperkinesia such as: | 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. | * 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 | * Unusual [[posture]] | ||
==References== | ==References== | ||
Latest revision as of 14:38, 2 April 2018
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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]
- Physical examination of patients with autism is usually remarkable for repetitive behavior, dyspraxia, abnormal gait, and abnormality of motor functions.
Appearance of the Patient
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
- Motor tics
- Motor delay
- Mental retardation (uncommon)
- Atypical language with pronoun reversal, use of non-sense words, echolalia or stereotyped phrases[5]
- Aprosody
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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.