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Autism
Physician
Handbook
Canadian
Edition
Table of Contents
Page 1
Page 3
Table of Contents
Page 4
Screening Tools
Page 5
CHAT Poster
Page 67
Page 8-10
Social Issues
Page 11
Communications Issues
Page 1215
Bizarre/Repetitive Behaviour
Page 1617
Motor Issues
Page 18
Sensory Overload
Page 1921
Sensory Issues
Page 22
Self-Injurious
Page 2325
Safety Issues
Page 26
Gastro-Intestinal Disturbances
Page 27
Page 28
Impact on Family
Page 29
Page 30
Acknowledgements
At 18 months of age
Does your child ...
1. Look at you
and point when
he/she wants
to show you
something?
2. Look when
you point to
something?
3. Use imagination
to pretend play?
Yes
No
Yes
No
03. Does your child play pretend or make-believe? (For example, pretend
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
11. When you smile at your child, does he or she smile back at you?
Yes
No
12. Does your child get upset by everyday noises? (For example, a
Yes
No
Yes
No
14. Does your child look you in the eye when you are talking to him or her,
Yes
No
Yes
No
16. If you turn your head to look at something, does your child look around Yes
No
(For example, if you point at a toy or an animal, does your child look
at the toy or animal?)
05. Does your child make unusual finger movements near his or her eyes?
(For example, does your child wiggle his or her fingers close to his or
her eyes?)
06. Does your child point with one finger to ask for something or to get
help? (For example, pointing to a snack or toy that is out of reach?)
07. Does your child point with one finger to show you something
interesting? (For example, pointing to an airplane in the sky or a big
truck in the road)
08. Is your child interested in other children? (For example, does your
child watch other children, smile at them, or go to them?)
09. Does your child show you things by bringing them to you or holding
them up for you to see not to get help, but just to share?
(For example, showing you a flower, a stuffed animal, or a toy truck)
10. Does your child respond when you call his or her name?
(For example, does he or she look up, talk or babble, or stop
what he or she is doing when you call his or her name?)
15. Does your child try to copy what you do? (For example, wave
bye-bye, clap, or make a funny noise when you do)
to see what you are looking at?
17. Does your child try to get you to watch him or her? (For example,
Yes
No
Yes
No
Yes
No
Yes
No
does your child look at you for praise, or say look or watch me)
18. Does your child understand when you tell him or her to do something?
(For example, if you dont point, can your child understand put the
book on the chair or bring me the blanket?)
19. If something new happens, does your child look at your face to see
how you feel about it? (For example, if he or she hears a strange or
funny noise, or sees a new toy, will he or she look at your face?)
20. Does your child like movement activities? (For example, being swung
or bounced on your knee)
6
SCORING ALGORITHM
NO responses indicating ASD risk:
All except questions 2, 5 and 12
YES responses indicating ASD risk:
Only questions 2, 5 and 12
The following algorithm maximizes psychometric properties of the M-CHAT-R:
Risk Assignment
High risk for autism group
Total Score of 8 - 20
Total Score of 3 - 7
Total Score of 0 - 2
Management recommendations:
High risk
group:
Medium
risk group:
Low risk
group:
Social
Communication
Bizarre / Repetitive Behaviours
Motor
Sensory Overload
Sensory
Self Injurious
Safety
May be vicious
with siblings
May show no
interest in
Peek-a-Boo or other
interactive games
May strongly
resist being held,
hugged or kissed
by parents
10
Unaware
of environment
Avoids eye-contact
Hand-Leading
11
Flapping
Spinning
12
Picking lint
in the sunlight
13
Rocking
Obsessively switching
light on and off
Flicks
fingers
in front
of eyes
Eats unusual
objects like clothes,
mattress or drapes
14
Finds ways
to get
deep-pressure
applied to body
Smearing feces
15
Poor coordination
Fine Motor Deficits
Toe-walking
16
OR
Clumsy
Exceptional Balance
Drooling
Unable
to ride
tricycles,
or trucks
17
A child with autism may have extreme difficulty tolerating music, noise,
textures and new experiences or environments. The greater number of
sensory exposures, the more likely a behavioural melt-down will occur.
18
Extreme difficulty
with haircuts
Unable to
tolerate
seat belts
May be almost
impossible to bathe
19
Spinning objects
close to face
20
Resists
having
clothing changed
21
Head-banging
Self-biting with no
apparent
pain
Ripping and
scratching at skin
Pulling out
handfuls of hair
22
No sense of danger
23
24
No fear of heights
25
Gastro-Intestinal Disturbances
Dr. Tim Buie, a Gastroenterologist at Harvard University and Mass General
Hospital, Boston, has performed endoscopies in over 1000 children with
autism. In the initial 400 children, he discovered that GI problems were
much more prevalent in children with autism than in normal controls.
20% Esophagitis
12% Gastritis
10% Duodenitis
12% Colitis
Undigested
food in stool
Diarrhea
Constipation
Severe self-limiting diet
and/or food sensitivity
26
Sleep-Disturbances/Pain Responses/Seizures
Sleep Disturbances
Children may go days without any apparent need to sleep. May not seem to
notice difference between day and night. May have difficulty going to sleep
and staying asleep. May only sleep brief periods of an hour or two maximum.
Consider the parents sleep-deprived state as a consequence.
Seizures
Co-morbidity with seizures
increasing with age.
Unknown etiology
28
4. Hearing Evaluation
5. Speech Therapy
6. Occupational/Physical Therapy
7. Nutritionist or Dietician
9. Chiropractor or Osteopath
30
As Physicians we are
primarily trained to
look for sickness.
Children with autism
rarely look sick; they
may look perfectly normal
and have attained all their
pediatric milestones.
31
32
Consider:
Scheduling the child as the first
appointment of the day, (ten minutes
earlier will prevent the child from
seeing other people when he arrives).
Potential Advantages:
Minimizes risk of:
1. Child melt-down
2. Disruption for other families
in the Waiting Room
3. Embarrassment for the parent
4. Damage to the actual Waiting Room
If possible register the child in advance by telephone.
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34
35
Acknowledgements
We would like to thank the Help Autism Now Society for creating this
wonderful handbook and for sharing it with us. By allowing us to
add our distinctly Canadian content it has, and will continue to be,
more accessible and helpful to a far greater number of families.
We would like to thank Bailey Metal Products and Starbucks Coffee Canada,
Toronto locations, for their generosity. Their support of this project allowed Autism
Canada to print and distribute the first run of the Autism Physician Handbooks.
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