Defining autism:

Conceptually a lifelong disorder of social impairment with ____ and/or _____ and _________.

When does autism usually appear?

(hint: during what age period in life)

social interaction

communication

imaginative play

autism

asper's disorder

PDD NOS

Rett's syndrome

Childhood disintegrative disorder

1. qualitative impairment in social interaction

2. qualitative impairments in communication

3. restricted repetitive and stereotyped patterns of behavior, interests, and activities

What category do these fit under?

How many do you need in order to classify someone with autism?

·  Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction/ flapping-soothing

·  Failure to develop peer relationships appropriate to developmental level

·  A lack of spontaneous seeking to share enjoyment (want to show you something), interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)

Lack of social or emotional reciprocity marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction/ cant understand why someone else is upset/ nodding head, waving, take turns when we speak/wont know that you want to stop talking

WHat category do these fit under and how many do you need to diagnose autism?

·  Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

·  In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

·  Stereotyped and repetitive use of language or idiosyncratic language

Communication impairment (need 1)

What category do these fit under and how many do you need to classify for autism?

·  Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

·  Apparently inflexible adherence to specific, nonfunctional routines or rituals

·  Stereotyped and repetitive motor manners (e.g., hand or finger flapping or twisting, or complex whole-body movements)

·  Persistent preoccupation with parts of objects

Need 1

need for "sameness"

·  Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

·  The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder. 

What is the prevalence of autism (epidemiology)?

Who gets it?

It is difficult to separate from ____

33% develop _____

·  Prevalence remains low but not as low as once thought (4-5/10,000)

·  Impairments evident before age 3

·  Males > Females (4:1)

·  75% have mild to moderate MR (not a diagnostic criteria)

·  50% never develop useful communication skills

·  33% develop seizure disorders

·  Familiar to people as Rainman, but “splinter skills” (aka savants) are uncommon

·  Difficult to separate from profound MR

IMP!!!

What are the early signs of autism?

·  No smiling by 6 months

·  No back and forth sharing sounds, smiles, or reciprocal facial expression by 9 months

·  No babbling, pointing, waving by 12 months

·  No single words by 16 months

·  No 2 word phrases by 24 months

·  Any loss of speech, babbling, or social skills

Asperger's

need at least two items

These are associated with what disorder? How many of the areas do you need to be diagnosed with the disorder?

·  Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:

–encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity of focus

–apparently inflexible adherence to specific, nonfunctional routines or rituals

–stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

–persistent preoccupation with parts of objects 

Asperger's

at least one item

·  The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. 

·  There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

·  There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

•Difficulty judging personal space, motor clumsiness

•Sensitivity to loud noises, clothing and food textures.

•Speech and language skills impaired in the areas of semantics, pragmatics, and prosody (volume, intonation, inflection and rhythm)

•Difficulty in understanding other’s feelings

•Pedantic, formal style of speaking often called the “little professor”, hyperverbal

•Extreme difficulty reading/interpreting social cues

•Socially and emotionally inappropriate responses

•Literal interpretation of language; difficulty comprehending implied meanings (does not understand jokes, metaphors, sarcasm)

What is PDD NOS?

What type of impairments?

PDD NOS

·  Impairment in social skills

·  Either impairments in communication OR “need for sameness” (both would give diagnosis of Autism)

Screening Instruments:

Checklist for Autism in Toddlers (CHAT)

Pervasive Developmental Disorders Screening Test (PDDST)

Diagnostic Instruments

Gilliam Autism Rating Scale (GARS)

Childhood Autism Rating Scale (CARS)

Gilliam Asperger’s Disorder Scale (GADS)

·  Eye contact may be better in _______, but generally PDD children look more __________

·  PDD children generally have __________

·  Social interest may be better in higher functioning PDD but still awkward (“super-nerds”)

·  Overall prevalence of all PDD is est. 1/160

Genetic roles

·  Eye contact may be better in Aspergers, but generally PDD children look more at mouths

·  PDD children generally have multiple mild neurologic deficits (clumsy physically, or sensory hypersensitivities)

·  Social interest may be better in higher functioning PDD but still awkward (“super-nerds”)

·  Overall prevalence of all PDD is est. 1/160

SSRI

Fluoxetine (Prozac) may help reduce

Early intervention can be very helpful – use the county Intermediate Unit for preschoolers; Easter Seals also can provide services

School age should have an IEP and (at a minimum) speech therapy, OT and PT assessments

–Speech therapy may want to assess “pragmatic language”

–OT for sensory desensitization protocols

How does a child work on playing with others?

ie. role of speech therapy, OT, PT

Speech therapists may focus on “auditory processing disorder”

OT may focus on “sensory integration disorder”

Parent may focus on having child in “autism support classes” without regard for integration or severity of disorder