Autism 101: An Introduction for Families

1. Autism 101:An Introduction for Families Lindsey Miller, ARNP Rachel Montague, Ph.D. June 5, 2012

2. What are Autism Spectrum Disorders? Prevalence & causes Characteristics & related issues Treatments Resources • Overview of Presentation

3. What Are Autism Spectrum Disorders? • Overview of Presentation • ASDs are brain-based developmental disorders that are present from birth and includes presence of • Social, • communicative, • and behavioral abnormalities (Diagnostic and Statistical Manual, IV (DSM-IV))

4. What is meant by “spectrum disorders”? • Symptoms can occur in a variety of combinations • Symptoms present with varying degrees of severity • Two children with a diagnosis of autism can have very different strengths and challenges and can act completely differently from one another • Intellectual abilities vary

5. Autism Triad – Current Model

6. What are Autism Spectrum Disorders (ASD)?

7. Autism – Proposed Model

8. Proposed model of ASD

9. CDC estimates that 1 in 88 childrenhave ASD This is up to a 10-fold increase since 1950s Similar rates across different cultures, ethnicities, or income level Current averages indicate that boys are 4.4 times more likely to be diagnosed with ASD as compared to girls • Prevalence of ASD

10. Why the increase in ASDs? • Several reasons: • Wider public awareness • Better assessment tools • We are now diagnosing kids with autism now who present with average or above average intellectual capabilities and more subtle social and language delays. • Is there a true increase? • ASDs may have been unrecognized or misidentified in the past

11. Genetics Identical twin studies: 60-90% of the time that 1 twin has ASD, the other does too. For sibling studies: 8-18% of the time that 1 sibling has ASD, another sibling does too. Even if the other siblings don’t meet criteria for ASD, they may have social difficulties, language impairment or developmental delay What causes it?

12. Environment There is also likely an environmental component research is trying to identify specific environmental factors What do we mean by “environment”? It’s likely a combination of genetics & environment The theory is that the genetic component can be turned on by an environmental trigger. What causes it?

13. We know some things do NOT cause ASD – such as vaccines or parenting In 2010, journal Lancet officially retracted the 1998 article that originally suggested a connection between autism and the MMR vaccine. Many years ago, people believed autism was caused by “bad parenting.” Research has shown that is not the case. What causes it?

14. ASD can sometimes be diagnosed as early as age 2by experienced clinicians Some children with ASD are diagnosed during school-age years. When is ASD diagnosed?

15. No medical test (e.g. blood test, brain scan) Diagnosis made using specific criteria Based on developmental history, direct observation and interaction with child, clinical judgment by qualified professionals Tools: Autism Diagnostic Observation Schedule (ADOS) often used, but not required Autism Diagnostic Interview (ADI) – semi structured parent interview about development How is ASD diagnosed?

16. Characteristics of ASDs Social Interaction Impairments Communication Impairments Restricted, Repetitive Behaviors

17. Difficulty using eye gaze, gestures, etc. Gestures include pointing, nodding, waving goodbye Few friendships Difficulty sharing enjoyment & interests with others. Difficulty relating to others, taking another’s perspective, and empathy Social Interaction Impairment

18. Language delays Difficulty with back-and-forth conversations. Repetitive and/or odd use of language. Communication Impairment

19. Abnormally obsessive interests Rigid adherence to routines “Stereotyped” motor movements Hand flapping, rocking, spinning, pacing Focus on the details, miss the big pictures Odd play skills • Patterns of Behavior

20. Inattention and/or Hyperactivity (ADHD) Anxiety Depression/ irritability Disruptive/ oppositional behaviors Sensory Processing Issues Motor Planning Issues Executive Functioning Tic disorders Related Issues in ASD

21. Visual learning Concrete skills Memory Consistency Following rules Attention to detail • Common Strengths for Children with ASD

22. Interventions for children with ASDs • There is no cure for ASD, but intervention lead to improvement and development of skills. • Intervention is recommended as soon as diagnosis is made. • With intervention, progress can be made in many areas. • What therapy is right for your child?

23. School Services • Children with ASD may qualify for special education services from birth to age 21 • Birth-to-Three Services for children under 3 • Individual Education Program (IEP) for children 3 to 21 • Depending on child’s needs, extra services may include: • speech language therapy, occupational therapy, social skills groups, and/or academic support • Inclusion and self-contained placements • Behavior support or positive behavior planning

24. Special Education Resources • WAC codes (Washington Administrative Code) http://www.k12.wa.us/specialed/ • Wrightslaw http://www.wrightslaw.com/ • Special Educational Ombudsman Office http://www.governor.wa.gov/oeo/ • Autism Speaks IEP Guide: http://www.autismspeaks.org/family-services/ community-connections/back-to-school

25. Private Therapies • Speech & Language Therapy • Occupational Therapy (sensory, fine motor) • Physical Therapy (gross motor, coordination) • Individual Therapy / Counseling • Social Skills Groups • Biomedical Treatments • Family Education & Therapy / Counseling • Parent Training & Information

26. Speech & Language Therapy • Communication Development • Talking and understanding what others are saying • Production of speech sounds (articulation) • Social Communication – “how and why we communicate” • Nonverbal Communication • School-based and private speech language pathologists

27. Occupational (OT) & Physical Therapy (PT) • Gross Motor Development – “large” motor movements -- PT • E.g., running/jumping • Fine Motor Development – “small” motor movements -- OT • E.g., using utensils/tools • Sensory Processing • School-based and private OT/PT

28. Common types of individual therapy: Cognitive Behavior Therapy (CBT) Child learns how thoughts, feelings and behaviors are connected Child learns coping skills for anxiety, anger, teasing, etc. Behavior Management Parents learn why child has certain behaviors and learns strategies to improve the child’s behaviors Applied Behavior Analysis (ABA) Can be provided by Masters level therapist or Ph.D. (psychologist) Individual Therapy

29. Social Skills Groups • Group of approximately 4-8 children with social skills difficulties, led by a therapist / teacher • Focus on development of social skills • making friends, starting and ending conversations, etc. • School-based and private groups • Excellent opportunity to practice skills learned in individual therapy!

30. Picky Eating GI (stomach, poop, etc.) Problems Seizures Sleep Disturbances Common Medical Issues in ASD

31. Biomedical • Medications can be used to treat some behaviors associated with ASD • Inattention, hyperactivity, aggression, irritability, anxiety • Complementary & Alternative Medicine (CAM) • Be careful to evaluate treatments prior to beginning, and talk to your doctor

32. Parent Support • Parent groups • FEAT of Washington • http://www.featwa.org/ • Autism Society of Washington • http://www.autismsocietyofwa.org/ • ALLY support group at Seattle Children’s Autism Clinic • Email lynn.vigo@seattlechildrens.org for information • TACA of Washington • http://www.tacanow.org/local-chapters/washington/

33. How to get in: Talk to your Primary Care Provider for referral Services offered: Diagnosis Medical treatment (psychiatry, neurology, neurodevelopmental, speech) Individual therapy (cognitive behavioral, behavior management) Treatment planning Seattle Children’s Autism Center

34. General Resources – Local • SCH Autism Center • Autism Blog: www.theautismblog.org • Information and Resources: http://www.seattlechildrens.org/clinics-programs/autism-center/ • Autism Outreach Project • http://www.nwesd.org/autism • Autism Society of Washington • http://www.autismsocietyofwa.org

35. General Resources – National and International • Autism Speaks • www.autismspeaks.org • Autism Society of America: • www.autism-society.org • Global Autism Collaboration (Center for the Study of Autism): • www.autism.org

36. Government Resources • Division of Developmental Disabilities (DDD) • Apply for eligibility/services • May receive services (although limited at this time) • Important to apply now so children may receive services in future • http://www.dshs.wa.gov/ddd/ • Tuesdays at 11am – free DDD application help at SCAC • Supplemental Security Income (SSI) • May be eligible for disability income • http://www.ssa.gov/ssi/

37. Autism Resource DVD, produced by University of Washington’s Autism Clinic Watch or download at http://depts.washington.edu/uwautism/resources/autism-resource-dvd.html Video Recommendations

38. Educating Children with Autism National Research Council My Social Stories Book Carol Gray More than Words Fern Sussman A Parents’ Guide to Asperger and High Functioning Autism Sally Ozonoff, Geraldine Dawson, and James McPartland Book Recommendations

39. THANK YOU!Please complete yourCourse Evaluations…QUESTIONS?