3abcde-Fgh of Autism3

A awareness
B behaviour
C cognition connection communication
D disorder
Dr Kondekar Santosh V
Associate Professor Pediatrics
T N Medical college Mumbai
MD DNB DCH FCPS FAIMER

Fellowship Pediatric Neurology & Epilepsy MUHS
PGDDN CDC Kerala
IAP Autism Trainer
Pioneer of Goal Directed Cognitive Approach In Autism

www.autismdoctor.in
1
DRKONDEKAR 9869405747 07/24/2024
• What is wrong?
• Where and How?
• Can there be a Single best way to explain Autism?
• How are the core symptoms developed?
• How do they worsen?
• How to pick and act.
• Act how?
• How do we get response?
What does the topic

mean 2
for a booklet on home based therapies whatsapp 91-9869405747 07/24/2024
• As definition of autism is widened to autism spectrum
disorder, many kids will be given this diagnosis – parents have
difficult time to accept
• Previously diagnosed autism kids, may not be autism by new
definitions in some cases
• As most specialists have been following DSM IV ISAA and
CARS tool for assessment; sticking to old diagnosis criteria
will result in wrong labels and wrong statistics. All needs to be
re-done.
• Autism was considered as a group of different symptoms, now
it can be explained as a sequential process.
Why we all may be wrong what we

assume 3
We always thought so 4
Or felt like a loose piece
missing 5
We had multiple
Every one talked about their own, but concluded in ambiguity
theories 6
From Genetics- like
fragile X 7
GENES
8
to quasi genetics 9
To epigenetics 10
Whatever way it happens,
the result is faulty / deficient neuronal
connections in developing brain
11
• Incomplete / Under-developed /excess
• Receiver neurons, central neurons, interneurons
• Chemical, physical,functional, electrical disconnections,
dissociations, disturbances
Faulty Neuronal
connections 12
Now autism is no longer a psychiatric disease but a
Neuro Developmental Disorder
Every pediatrician SHALL take care off.
13
A sensory CP, the sense is missing
One time deficit in
some group of sensory- connecting neurons
Input –processing-output 14
POSSIBILITY OF CONNECTIONS IS ENDLESS AS WIDE
AS AUTISM SPECTRUM
15
Sense-ory Pathways 16
Internal Sense-ry Integration 17
The sensory network.. #MakingSense 18
The true or Internal sensory integration .. That builds
cognition 19
• Immunity
• Infection
• Inflammation
• Toxins
• Oxidative stress or cytokines FAILING
• Dietary deficiency THEORIES
• Dysbiosis** / Probiotics
• Metabolic diseases
• All above theories- it shall progress
Autism is a developmental deficit that turns into disorder due
to sensory discordance, the sense is not interpreted in sensory
way due to paucity of speed or connections
Its not a disease to be explained by above 20

21
LIKE AN EVOLVING CP
Symptoms of autism seem to be changing not as

a part of disease progression but as an inability
to respond to developmental maturation 22
At times [<2013] autism is linked to diseases and
syndromes, due to symptom overlap
• Syndromic Epilepsy
• Tuberous Sclerosis
• Mitochondrial diseases
• THESE DO PROGRESS…
• When the symptoms are best explained by any known
disease or abnormality as above, it shall be called by its
name and not as Autism Spectrum Disorder.
• This is the biggest change with DSM 5 Autism criteria E
23
OVERLAP 24
Pathogenesis of DSM 5 symptom profile sequence in autism spectrum
25
DEVELOPMENTAL TRAJECTORIES
for a booklet on home based therapies whatsapp 91-

07/24/2024 9869405747 26
27
Even for adult autism, childhood onset is must.
AN ADULT WITH AUTISM MAY HAVE MANY SUCH ISSUES
BUT IT ALL STARTS BEFORE AGE 5 YEARS ANY TIME UPTO AGE
OF CONCEPTION
BUT MAY NOT MANIFEST IN ALL UNLESS A CHALLENGING

LEARNING IS DEMANDED AS PER AGE 28
Age inappropriateness is key to noticing
deficit
SURELY YOUR KID MAY BE ABLE TO DO SOME

COMMUNICATION AND YOU MAY FEEL YOUR KID IS LEARNING
AND WILL PICK UP, ITS NOT ALWAYS SO
AS OFTEN
AS A PARENT Often ENDS UP NEGLECTING AGE DEFICIT/ AGE

APPROPRIATENESS AND QUALITY OF MILESTONE AS PER AGE
so when you ask history, parent will say the kid knows
and does all, but what he misses in age
inappropriateness. 29
Neurodevelopmental deficit
• Action or movement deficit
• Presents like Cerebral Palsy
CP
• Processing deficit
Intell
ectua • Presents with less understanding, mimicks
lly autism
disab
led
• Sensory /communication deficit

Socia • Presents like autism
l CP
30
Social Emotional Communication
Minor software issues involve few fibres so needs special MRI like DTI or fMRI
31
Control centers
32
Sensing the senses: 5 senses
Presents as hypo
hyper or normal
sensitivity to any
sense often present
but not must
vision, hearing, touch/pain/temperature,
taste, smell
33
Two special senses: Sense the
Sensory
• vibration/ vestibular and proprioception/ balance
34
Two hidden senses: Sense the
Sensory • Sense of breathing > >> Repeated cough
• Sense of indigestion or gut movements >>>
indigestion constipation
All 9 SENSES, PRESENT AS LOW OR HIGH RESPONSE
LOW RESPONSE: IF CENTRAL PROCESSING AFFECTED SPD

HYPER RESPONSE IF PERIPHERAL INPUT PERCEPTION more AFFECTED
Sensory Diversion
AND THERE IS 10TH SENSE, sense of cognition-recognition ,

if low, kids have low IQ
BEING A SPECIAL / HYPER INTELLECTUAL , THOUGH RARE, was called Asperger

or HF autism in old system 35
36
Abcde-fgh
of autism
DSM 5
Diagnostic and therapeutic perspective
AUTISM BASICS 37
DRKONDEKAR 9869405747 07/24/2024
• Dsm 5 perspective
• Diagnostic dilemma: flags/screening/differentials and
delays
• Diagnostic tools
• Defining autism / denying diagnosis
• Legal implications
• Symptoms to guide treatment /tests
Objectives
DRKONDEKAR 9869405747
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07/24/2024
• In 2013, autism diagnostic criteria is changed and its no
longer just autism but it also includes many autism like
conditions of behavior and communication , and that
makes us see cases rising too.
• So its now called a spectrum, means a large number of
spectrum will be close to normal and independent.
Why dsm 5 is important? 39

DRKONDEKAR 9869405747 07/24/2024
• It is the first ever international criteria that truly
explains autism.. Since 2013
• The sequence of events develop in the sequence of dsm
criteria
• So when we want to reverse changes we truly need to
change the symptoms from core.. And so the sequential
symptoms will start getting reduced over next few
months.
Why dsm 5 is important? 40

DRKONDEKAR 9869405747 07/24/2024
Once we know how it is happened.
We know how to reverse it.
Why dsm 5 criteria is important?

41
DRKONDEKAR 9869405747 07/24/2024
• Autism core criteria of persistent deficit like
• A1: social communication/interaction deficit, social
initiation and reciprocation deficit
• A2: non verbal communication deficit and
• A3: deficit in understanding and maintaining
relationships
• One each of a1 a2 a3 is must
Connect communicate to converse
A of autism: awareness- action 42

DRKONDEKAR 9869405747 07/24/2024
A1.1 Social approach abnormal
A1.2 Abnormal back forth conversation
A1.2 Reduced sharing of interest emotion/ affect
A1.4 Failure to initiate or respond to social
interactions
A1: social emotional reciprocity 43

DRKONDEKAR 9869405747 07/24/2024
A2.1 Poor verbal / non verbal communication,
poor eye contact
A2.2 Poor body language
A2.3 Deficit in gesture use or
A2.4 Total lack of facial expressions or non verbal
communication
A 2: any 1
deficit in nonverbal
communication 44
DRKONDEKAR 9869405747 07/24/2024
A3.1 Deficit in developing maintaining and
understanding relationships
A3.2 Difficulty adjusting behavior to suit various social
context
A3.3 Difficulty in sharing imaginative play or making
friends
A3.4 Absence of interest in peers
A3: deficit in understanding and

maintaining relationships 45
DRKONDEKAR 9869405747 07/24/2024
Behavioral patterns..
B1 Repititive
B2 Fixed/rigid
B3 Object fascinations
B4 Sensory issues
B of autism: any 2
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07/24/2024
B1.1 Use of objects
B2.2 Simple motor stereotypes
B2.3 Lining up toys
B2.4 Flipping objects
B2.5 Echolalia
B2.7 Idiosynchratic phrases
B1: stereotyped or repititive

motor movements 47
DRKONDEKAR 9869405747 07/24/2024
B2.1 Extreme distress at small changes
B2.2 Difficulty with change or transition
B2.3 Rigid thinking pattern
B2.4 Greeting rituals
B2.6 Need to take same route
B2.7 Eat same food every day
B2: sameness / rigidness/

inflexibility/ rituality verbal or non
verbal 48
DRKONDEKAR 9869405747 07/24/2024
B3.1 Strong attachment / preoccupation with
unusual objects
B3.2 Excessive circumscribed or perservative
interests
obsessions
B3: restricted fixated interest of

abnormal intensity / focus 49
DRKONDEKAR 9869405747 07/24/2024
B4.1 Apparent indifference to pain and temperature
B4.2 Adverse response to sound or texture
B4.3 Excessive smelling or touching of objects
B4.5 Visual fascination with light or movement
B4: hyper or hypo reactivity to sensory

input or unusual interest in sensory
aspects around 50
DRKONDEKAR 9869405747 07/24/2024
• Condition for definition is that symptom onset should
be before 6 years of age,
• previously it was five years of age; that was making

many ASD cases to be wrongly diagnosed as adhd after
age 3 years.
C of autism: condition of childhood age51

DRKONDEKAR 9869405747 07/24/2024
• Disability in autism should be clinically significant and
relevant to affect education and occupation
• Meaning if we educate/enable an autism kid and enable
them to do better, the kid can be close to mainstream.
D of autism: disability DISTURBING

significance 52
DRKONDEKAR 9869405747 07/24/2024
• Exclusion of other diseases explaining autism features
in the child is compulsory.
• If any symptoms are better explained by other diseases,
one should refrain from calling it as autism, and it may
have different way to manage too. Rett, Asperger, Frax
E of autism
53
07/24/2024
• Frequent close follow up management in every child
with autism label is important along with early active
interventional therapy..
• With a follow up plan with a follow up diary to be
charted weekly without spending more than 5 min
• No change in hundred days with any plan should make
one change the experts involved.
F of autism
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07/24/2024
• Goals are most important
• Simple achievable frequent modifiable
• Definite 3 to 5 goals
• To be planned in steps each month
• And work towards it
• They will be met with hardwork, keep target 100 days.
• Not met, don’t give up.. Modify goals, work hard, change
experts
G of autism
55
07/24/2024
• Hope takes us forward
• Each goal puts you thro hopes
• See the change, record the change, believe the change
• Hope for the next best
• Ask for more
H of autism: hope 56
DRKONDEKAR 9869405747 07/24/2024
And we do see often
Intermittent: indigestion,
irritability, constipation 57
DRKONDEKAR 9869405747 07/24/2024
• Click http://bit.ly/Autismgroup
J of Autism
Join a Support Group 58
DRKONDEKAR 9869405747 07/24/2024
59
DRKONDEKAR 9869405747 07/24/2024
www.
Neuropediatrician.com 60
DRKONDEKAR 9869405747 07/24/2024
Early detection red flags 61
DRKONDEKAR 9869405747 07/24/2024
Detailed neuropediatric and developmental assessment
Noting clinical markers towards aetiology delay or
differential diagnosis
Multidisciplinary assessment
DSM IV – ISAA CARS INCLEN, TABC
DSM V – INCLEN Modified, 3Di, ADOS2, DISCO 11
Diagnosis is purely clinical based on questionaires and ruling
out other diagnoses
HIGH SENSITIVITY OF DIAGNOSIS IS IMPORTANT TO
START EARLY INTERVENTIONS.
Diagnostic tools 62
DRKONDEKAR 9869405747 07/24/2024
10% OF TOTAL AUTISM CASES ARE GENETIC
3% ARE FRAGILE X
A WIDE UNEXPLORED SPECTRUM
Genetic /metabolic
syndromes 63
DRKONDEKAR 9869405747 07/24/2024
EVOLVING AUTISM
AS OFTEN THE SYMPTOM, COMPLEX IS NOT FULLY
ELICITABLE AS PER QUESTIONARES, MANY
EXPERTS REFRAIN FROM LABELLING AS AUTISM.
Autism: < 3 year age 64

DRKONDEKAR 9869405747 07/24/2024
• IN INDIA, legal diagnosis is only by ISAA.
• Overdiagnosis has legal implications due to sufferings
parents go through.
• So, always better diagnose as “suspected spectrum
disorder, pending exclusion of other diagnoses”
Legally how does it differ 65

DRKONDEKAR 9869405747 07/24/2024
•E
Its important to know
whats not autism 66
DRKONDEKAR 9869405747 07/24/2024

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A awareness

MD DNB DCH FCPS FAIMER

Pioneer of Goal Directed Cognitive Approach In Autism

What does the topic

Why we all may be wrong what we

Its not a disease to be explained by above 20

Symptoms of autism seem to be changing not as

for a booklet on home based therapies whatsapp 91-

AN ADULT WITH AUTISM MAY HAVE MANY SUCH ISSUES

BUT MAY NOT MANIFEST IN ALL UNLESS A CHALLENGING

SURELY YOUR KID MAY BE ABLE TO DO SOME

AS A PARENT Often ENDS UP NEGLECTING AGE DEFICIT/ AGE

• Sensory /communication deficit

LOW RESPONSE: IF CENTRAL PROCESSING AFFECTED SPD

AND THERE IS 10TH SENSE, sense of cognition-recognition ,

BEING A SPECIAL / HYPER INTELLECTUAL , THOUGH RARE, was called Asperger

Why dsm 5 is important? 39

Why dsm 5 is important? 40

Why dsm 5 criteria is important?

Connect communicate to converse

A of autism: awareness- action 42

A1: social emotional reciprocity 43

A3: deficit in understanding and

B1: stereotyped or repititive

B2: sameness / rigidness/

B3: restricted fixated interest of

B4: hyper or hypo reactivity to sensory

• previously it was five years of age; that was making

C of autism: condition of childhood age51

D of autism: disability DISTURBING

A WIDE UNEXPLORED SPECTRUM

Autism: < 3 year age 64

Legally how does it differ 65

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