AUTISM SPECTRUM DISORDERS DIAGNOSIS AND TREATMENT OPTIONS

1. AUTISM SPECTRUM DISORDERS DIAGNOSIS AND TREATMENT OPTIONS BY DR (MRS) E.A.E. ALUKO MB BS FWACP, DAAP

2. Autism • Defined as a Behavioral Disorder Characterized by Treatable Medical Problems

3. Autism • Impairments in communication • Problems with social interactions • Repetitive, restrictive or stereotyped behaviors • Consider the concept of Autisms

4. Autism as a genetic syndrome There are some classic genetic syndromes that are characterized by autistic behavior William’s syndrome Cri du Chat Rett’s syndrome

5. BUT Classic Genetics Cannot Explain Increased Illness In Children • Increase Over the Past 20 Years - Autism: 6000% increase * 1:1000 ---------- 1/50 * ADHD 400% increase * Asthma 300% increase * Allergies 400% increase

6. Paradigm for understanding Autism Genetic Susceptibilities Environmental triggers Timing & Development

7. OVERVIEW • Introduction • What are ASD • Who are the qualified professionals for diagnostic assessments • Diagnostic criteria for medical diagram.

8. AUTISM SPECTRUM DISORDERS • Developmental Disability not visible at birth • Different Brain Structure complex genetic interaction • Complex Disorder many areas affected • Wide Range of Impairment mild to severe across areas

9. ASD STATISTICS • Estimates 1 in every 110 children for spectrum • Present before the age of 3, but diagnosis often later • Found in all cultures and economic groups • Four times more common in boys

10. 3 AREAS AFFECTED • Reciprocal Social Interactions • Communication • Behaviors and Interests - Development in these areas follows a DIFFERENT path than that of most children - Differences are QUALITATIVE

11. ASDorPDD A SPECTRUM 1.Asperger’s Disorder 2.Atypical Autism/PDD-NOS 3.Austistic Disorder 4.Rett’s Disorder 5.Childhood Disintegrative Disorders

12. ASD DIAGNOSIS • Based on observable behaviors no medical test to diagnose autism or related disorders • Pattern of development • Social, Communication, Behavioral Profile • Developmental History Important • Rule out other Disorders

13. Delays or abnormal functioning in at least 1 of the following areas, with onset prior to age 3 years *social interaction *language as used in social communication *symbolic or imaginative play

14. DSM-1V CRITERIA : AUTISTIC DISORDER • Qualitative impairment in reciprocal social interaction(2) .marked impairment in use of multiple non verbal behaviors to regulate social interactions .failure to develop peer relationships appropriate to developmental level .a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people .lack of social or emotional reciprocity

15. Qualitative impairment in communication (1) *delay in, or total lack of, the development of spoken language *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 *lack of varied, spontaneous make-believe play or social initiative play appropriate to developmental level

16. Restricted, repetitive, and stereotyped patterns of behavior, interests and activities *encompassing preoccupations h 1 or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus *apparently inflexible adherence to specific, non functional routines or rituals *persistent preoccupation with parts of objects

17. DSM-1V CRITERIA: ASPERGER’S DISORDER *Qualitative impairment in reciprocal social interaction *Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities *There is no clinical significant general delay in language .Single words by 2 yrs .Communicative phrases by 3 yrs *There is no clinically significant delay in cognitive development .Average or Above Average IQ score

18. DSM-1V CRITERIA: PDD-NOS • Severe and pervasive impairment in development of social interaction • Impairment in either .verbal or nonverbal communication skills OR .with the presence of stereotyped behavior, interests, and activities

19. DIAGNOSING AUTISM FIRST STEP SCREENING THEN REFERRAL FINALLY EVALUATION AND DIAGNOSIS

20. EARLY DIAGNOSIS LEADS TO HIGH LEVELS OF RECOVERY

21. SCREENING FOR ASD *Child ideally younger than 3years *Best done between ages 12mnths-24mnths

22. Done on 2 levels Level 1 Primary caregiver reports Numerous screening forms exist CHAT ESAT CSBS

23. M-CHAT Please fill out the following about how your child usually is. Please try to answer every question. If the behavior is rare (e.g..you’ve seen it once or twice),please answer as if the child does not do it. 1. Does your child enjoy being swung, bounced on your knee, etc.? Yes No 2. Does your child take an interest in other children? Yes No 3. Does your child like climbing on things such as up stairs? Yes No 4. Does your child enjoy playing peek-a boo/hide-and-seek? Yes No 5. Does your child ever pretend, for example, to talk on the phone or take care of a doll or pretend other things? Yes No 6. Does your child ever use his/her index finger to point, to ask for something? Yes No

24. M-CHAT (cont) 7. Does your child ever use his/her index finger to point, to indicate interest in something? Yes No 8. Can your child play properly with small toys (e.g. cars or blocks) without just mouthing, fiddling, or dropping them? Yes No 9. Does your child ever bring objects over to you (parent) to show you something? Yes No 10. Does your child look you in the eye for more than a second or two? Yes No 11. Does your child ever seem over sensitive to noise? (e.g.. Plugging ears) Yes No

25. M-CHAT (CONT) 12. Does your child smile in response to your face or your smile? Yes No 13. Does your child imitate you? (e.g..you make a face-will your child imitate it?) Yes No 14. Does your child respond to his/her name when you call? Yes No 15. If you point a toy across the room, does your child look at it? Yes No 16. Does your child walk? Yes No 17. Does your child look at things you are looking at? Yes No 18. Does your child make unusual finger movements near his or her face? Yes No

26. M-CHAT (CONT.) 19. Does your child try to attract your attention to his/her own activity? Yes No 20. Have you ever wondered if your child is deaf? Yes No 21. Does your child understand what people say? Yes No 23. Does your child look at your face to check your reaction when faced with something unfamiliar? Yes No

27. LEVEL 2 • PROFESSIONAL REPORTS • FOCUSED ON BEHAVIOR • CSBC • PDDST • STAT • CARS (Childhood Autism Rating Scale) • CARS most commonly used tool by professionals

28. COLLATION OF ALL INFORMATION if suggestive RERRERAL FOR EVALUATION

29. WHO IS QUALIFIED TO MAKE AN ASD DIAGNOSIS? *Due to complexities in diagnosis relating to range of behaviors various professionals are needed. * MULTIDISCIPLINARY TEAM

30. MULTIDISCIPLINARY TEAM • Special educators • General educators • Psychologists • Speech-language pathologists • Occupational therapists • Physical therapists • Physician(e.g., neurologist, pediatrician)

31. Multidisciplinary team should be supervised by one of the following ; *Licensed Clinical Psychologist *Licensed Physician/Pediatrician *School psychologist

32. DIAGNOSING ASDs

33. *Developmental history is important *Rule out other disorders

34. DIAGNOSIS Evaluation and GOLD STANDARD ASSESMENTS

35. STATE-OF-THE-ART (Gold Standard assessments) EVALUATION FOR ASD • Medical examination • Parent interview (ADI-R) • Individual observation (ADOS by Professionals) • Developmental language testing

36. MEDICAL EXAMINATION *Physical examination *Rule out hearing / vision impairments *Genetic Testing *Neurological Examination

37. PARENT INTERVIEW ADI-R *Developmental history *Semi-structured interview about social skills *Communication *Behaviors and *Adaptive skills

38. ADI-R (Physician administered) Extensive Primary Caregiver Interview (93items) * Early Development (7) *Acquisition and Loss of Language/Other Skills (20) *Language and Communication Functioning (21) *Social Development and Play (10) *Favorite Activities and Toys (7) *Interests and Behaviors (13) *General Behaviors (13)

39. AUTISM DIAGNOSTIC OBSERVATION SCHEDULE (ADOS) *Play/Interview-based assessment *Five modules .Toddler (12-30months) .Preverbal/single words .Phrase speech .Fluent speech: Child/Adolescent .Fluent speech: Adolescent/Adult

40. NOW THAT I HAVE A DIAGNOSIS….. *Opportunity to educate physicians, teachers, community providers about .Diagnostic resources .Early signs .Referrals for intervention *Be On Same Page .Everyone in life .Follow-up diagnosis? *Start services and treatment

41. WHAT SERVICES SHOULD MY CHILD RECEIVE? * Services should be based on .3 main domains associated with ASD’S - Social interactions - Communication - Behaviors and Interests .Those specific challenges of ASD that face your child - ASD is not a one-size-fits-all - Should be tailored to those ASD criteria your child meets

42. SERVICES SHOULD *Promote independence and social responsibility *Ameliorate behavioral difficulties *Promote generalization across multiple environments *IFSP/IEP/ISP vehicle for planning and implementing objectives and benchmarks .Observables .Moderate behaviors and skills .Achievable within 1 year .Expect to affect participation in -Education -Community -Family life

43. SERVICES (CONT.) *Social skills .Imitate others .Social initiations to others .Response to adults AND peers -Needs access to typical peers .Parallel and interactive play with peers and siblings *Communication .Expressive verbal language .Repetitive language .Nonverbal communications skills .Functional symbolic communication system

44. SERVICES SHOULD (CONT.) *Increase engagement and flexibility in developmentally appropriate activities and play *Attend to the environment *Respond to appropriate motivational system *Motor skills .Fine and gross .Age appropriate functional activities *Cognitive skills .Symbolic play .Basic concepts .Academic skills

45. SERVICES SHOULD (CONT.) *Replace problem behaviors .More conventional and appropriate behaviors *Increase independent organizational skills .Success in general education classrooms *Include parents and families as meaningful team members – They are experts on their child *Be consistent across settings .Home, school, community.

46. CONCLUSIONS • Diagnosis of ASD is a label that can get services • Label assists others to know what skills are areas of strengths and which are areas of needs • No two individuals with ASD are alike • Services should be tailored to individual’s strengths and needs

47. THANK YOU DR (MRS) E.A.E. ALUKO MB BS FWACP, DAAP