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Clinical Atlas Prestige · Evidence-first

Psych VivasChild and adolescent psychiatry — neurodevelopmental

Psych Vivas · Child and adolescent psychiatry — neurodevelopmental

Autism spectrum disorder — structured clinical viva

Fellowship viva on ASD criteria and levels, differentials, ESDM/PACT/parent training, RUPP risperidone and Owen aripiprazole for irritability, capacity and transition.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the CAMHS psychiatry registrar. Parents of an 8-year-old with confirmed ASD ask: (1) Is there a tablet that treats autism? (2) His aggression is dangerous — what medicine is evidence-based? (3) Could this be ADHD or just anxiety? (4) What happens when he turns 18? Discuss criteria, differentials, behavioural care, risperidone/aripiprazole evidence with monitoring, suicide/mortality awareness, and transition planning.

Interpretation

Reveal interpretation

"Tablet for autism?" No medication treats core social-communication deficits as a primary indication. Foundations are educational supports, speech/OT, behavioural and parent-mediated interventions (name ESDM, PACT, parent training). Medicines treat comorbidities and severe irritability only.[1][4]

Dangerous aggression. Functional analysis and medical pain screen first. If severe irritability persists, discuss risperidone (RUPP evidence) or aripiprazole (Owen evidence): low start, slow titration, baseline and serial metabolic monitoring, EPS/prolactin (risperidone) or akathisia (aripiprazole), time-limited goals and review for dose reduction when safe.[2][3]

ADHD or anxiety? Both commonly co-occur; dual diagnosis is allowed when criteria are met. Discriminate social interest and developmental RRB pattern from pure inattention or fear-of-scrutiny anxiety. Treat each problem that meets threshold with adapted approaches.[1]

Age 18. Plan transition early: written care plan, adult service handover, education/employment, capacity is decision-specific with support, safeguarding for exploitation, and mental health follow-up — premature mortality and suicide risk mean physical and mental health cannot be ignored across the lifespan.[5][6]

Name evidence. Hyman AAP; McCracken RUPP; Owen aripiprazole; Dawson ESDM; Hirvikoski mortality; Cassidy suicide framing.[1][2][3][4][5][6]

Key points

Core ASD is not a drug target

Behavioural and educational care first; antipsychotics only for severe irritability with monitoring.

Dual diagnosis is allowed

ADHD, anxiety and ID frequently co-occur — treat what is present.

Transition is clinical work

Do not discharge at 18 into a void; written multiagency plan is mandatory good practice.
[1] [5]

References

  1. [1]Hyman SL, Levy SE, Myers SM; Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics Identification, Evaluation, and Management of Children With Autism Spectrum Disorder Pediatrics, 2020.PMID 31843864
  2. [2]McCracken JT, McGough J, Shah B, et al.; Research Units on Pediatric Psychopharmacology Autism Network Risperidone in children with autism and serious behavioral problems N Engl J Med, 2002.PMID 12151468
  3. [3]Owen R, Sikich L, Marcus RN, et al. Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder Pediatrics, 2009.PMID 19948625
  4. [4]Dawson G, Rogers S, Munson J, et al. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model Pediatrics, 2010.PMID 19948568
  5. [5]Hirvikoski T, Mittendorfer-Rutz E, Boman M, Larsson H, Lichtenstein P, Bölte S Premature mortality in autism spectrum disorder Br J Psychiatry, 2016.PMID 26541693
  6. [6]Cassidy S, Rodgers J Understanding and prevention of suicide in autism Lancet Psychiatry, 2017.PMID 28551299