Makindo Medical Notes

🧩 Autism Spectrum Disorder (ASD) is a neurodevelopmental condition affecting how people communicate, interact, and experience the world. 🌈 It is called a spectrum because every individual’s presentation is unique — ranging from subtle social differences to profound support needs. 💡 Recognising both strengths and challenges is central to good care.

🔑 Key Features of ASD

• 🤝 Social Communication Differences: Difficulty with eye contact, non-verbal cues, or back-and-forth conversations.
• 🔄 Repetitive Behaviours: Hand-flapping, echolalia, lining up objects, or rituals.
• 🎯 Restrictive Interests: Intense focus on specific topics (e.g., trains, dinosaurs, numbers).
• 🎧 Sensory Sensitivities: Over/under sensitivity to light, sound, touch, smell, or taste.

📌 For Clinicians

• 🧬 Heterogeneous condition → no single presentation, no single treatment.
• 👩‍⚕️ Multidisciplinary assessment (paediatrics, psychiatry, speech & language therapy, psychology).
• ⚖️ Management is tailored: therapies > medication. Drugs only for comorbidities (anxiety, ADHD, irritability).

🧪 Diagnosis

• 🧒 Developmental Screening: Routine checks in early childhood; early recognition = better outcomes.
• 🔬 Comprehensive Assessment: Clinical history, observation, caregiver input, and tools like ADOS (Autism Diagnostic Observation Schedule).
• 📖 DSM-5 Criteria: - Social communication deficits across contexts. - Restricted/repetitive behaviours or interests. - Symptoms present early in development. - Functional impairment in daily life.

🛠️ Management

• 🧠 Behavioural Interventions: Applied Behaviour Analysis (ABA), social skills training.
• 🏫 Educational Support: Individualised Education Plans (IEPs) under the UK SEND framework.
• 🗣️ Speech & Language Therapy: To build communication skills (verbal & non-verbal).
• 🖐️ Occupational Therapy: Focus on daily living skills, motor skills, sensory regulation.
• 💊 Medications: Not for ASD itself — but may help with ADHD, anxiety, aggression, or sleep issues.

🤝 Common Comorbidities

• ⚡ ADHD
• 😟 Anxiety or depression
• 🧮 Intellectual disability
• ⚡ Epilepsy (20–30%)
• 🌙 Sleep problems
• 🍽️ GI issues (constipation, reflux, abdominal pain)

📈 Prognosis

🌟 Outcomes are highly variable: - Some individuals live independently and excel in areas of strength (e.g., maths, art, technology). - Others require lifelong structured support. 🚀 Early recognition + tailored interventions → best chance of independence, wellbeing, and quality of life.

💡 Teaching Pearls

• 👀 "Red flag": lack of response to name, poor joint attention, or absence of pointing by 18 months → consider referral.
• 🎨 Strength-based approach: many individuals show exceptional skills in memory, pattern recognition, or creativity.
• 📣 Listen to the voice of the individual and family — they are experts in their own needs.
• 🛡️ Clinicians’ role is to support, not 'normalise' behaviour.

🔗 References

• NICE: Autism in under 19s
• NICE: Autism in adults
• DSM-5, American Psychiatric Association (2013)