Autism physical examination: Difference between revisions
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==Physical Examination== | ==Physical Examination== | ||
Clinical signs of autism are generally visible by three years of age | 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. | ||
* 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, 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). | * 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. | * 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=== | ===Appearance of the Patient=== | ||
*Patients with | *Patients with autism usually appear anxious with repetitive behavior. | ||
===Skin=== | ===Skin=== | ||
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===HEENT=== | ===HEENT=== | ||
* | * I'''ncreased head circumference (may return ti normal in adolescence)''' | ||
* Evidence of trauma | * '''Evidence of trauma''' | ||
* | * '''Lack of eye contact''' | ||
* '''Extra-ocular movements may be abnormal with unable to fix gaze''' | |||
* 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''' | ||
*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 and non-verbal communication''' | ||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with | * Neck examination of patients with autism is usually normal. | ||
===Heart=== | ===Heart=== | ||
* Cardiovascular examination of patients with | * Cardiovascular examination of patients with autism is usually normal. | ||
===Abdomen=== | ===Abdomen=== | ||
Abdominal examination of patients with | Abdominal examination of patients with autism is usually normal. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
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* '''Motor tics''' | * '''Motor tics''' | ||
* '''Motor delay''' | |||
* '''Mental retardation''' | * '''Mental retardation''' | ||
* Atypical language with pronoun reversal, use of non-sense words, echolalia or stereotyped phrases | * Atypical language with pronoun reversal, use of non-sense words, echolalia or stereotyped phrases | ||
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*Patient is usually oriented to persons, place, and time | *Patient is usually oriented to persons, place, and time | ||
===Extremities=== | ===Extremities=== | ||
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* 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. | ||
==References== | ==References== | ||
Revision as of 02:06, 2 April 2018
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Autism Microchapters |
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Autism physical examination On the Web |
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American Roentgen Ray Society Images of Autism physical examination |
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Risk calculators and risk factors for Autism physical examination |
- Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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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 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 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 blind or deaf or who have other serious sensory or motor disorders such as cerebral palsy or muscular dystrophy.
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].
OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
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 and language deficits. However routine early screening helps in early identification of autism in infants and toddlers.
- 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
- 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
- Increased head circumference (may return ti normal in adolescence)
- Evidence of trauma
- Lack of eye contact
- 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
- Delayed verbal and non-verbal communication
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
- Neuromuscular examination of patients with [disease name] is usually normal.
- Motor tics
- Motor delay
- Mental retardation
- 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 examination of patients with autism may show hyperkinesia such as:
- Hand flapping with a flaccid wrist; iIt 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.