Autism physical examination

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:

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.