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Pervasive Developmental Disorder. PS 572 Language & Social Skills For Individuals with Autism Sharon A. Reeve, PhD, BCBA. Today…. Review syllabus Pick #s for webpage grade sheet Pick Topic Discuss PDD diagnostic criteria Discuss Evidence-Based Practice. Overview of Presentation.

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Pervasive Developmental Disorder

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Pervasive developmental disorder l.jpg

Pervasive Developmental Disorder

PS 572 Language & Social Skills

For Individuals with Autism

Sharon A. Reeve, PhD, BCBA


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Today…

  • Review syllabus

  • Pick #s for webpage grade sheet

  • Pick Topic

  • Discuss PDD diagnostic criteria

  • Discuss Evidence-Based Practice


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Overview of Presentation

  • History of Autism

  • Diagnostic Characteristics and Prevalence

  • Causes


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Evolution of Term Autism

  • First used by Swiss psychiatrist Eugen Bleuler in early 1900s to describe persons with schizophrenia

    • Derived from the Greek autos (self) and ismos (condition)

    • Describes idea of “turning inward on one’s self”

  • In 1943 Psychiatrist Leo Kanner used term “infantile autism” to describe a group of children who were socially isolated, behaviorally inflexible, and had impaired communication

  • 1944 Psychiatrist Hans Asperger describes “little professor” syndrome


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Evolution of Term Autism

  • 1967, Bruno Bettelheim’s The Empty Fortress published

  • 1968 DSM-II (Diagnostic and Statistical Manual of Mental Disorders) lists autism as type of childhood schizophrenia

  • 1980 DSM-IIIplaces autism within Pervasive Developmental Disorders

  • 2000 DSM-IV-TR is current classification system we will be talking about


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What Are Pervasive Developmental Disorders (PDD)?

  • Pervasive developmental disorders are characterized by severe impairment in several areas of development:

    • Social interaction skills

    • Communication skills

    • Presence of stereotyped behavior, interests, and activities


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What Are Pervasive Developmental Disorders (PDD)?

  • These disorders are usually evident in the first few years of life (before age 3) and are often associated with some degree of mental retardation

  • They may be observed with a diverse group of other general medical conditions (e.g., chromosomal abnormalities, congenital infections, structural abnormalities of the central nervous system)


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Specific Pervasive Developmental Disorders

  • Autistic Disorder

  • Rett’s Disorder

  • Childhood Disintegrative Disorder

  • Asperger’s Disorder

  • Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)


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Popular Name for Pervasive Developmental Disorders


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What are ASDs Technically Speaking?

  • Continuum comprised of autism, Asperger’s, and PDD-NOS (Volkmar & Klin, 2005)

  • “the concept of autism is evolving from the singular autistic disorder into the plural autistic spectrum disorders (ASDs)” (Filipek, 2005, p.535)

    • In the 1970s, researchers collected data on children in the UK who had any features of autism

    • Found that impairments were manifested in many different ways and called it the autistic continuum

    • Currently, some researchers prefer the term spectrum to continuum because it does not imply a smooth transition from one end to the other (Wing, 2005)


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Asperger’s Disorder

  • Severe and sustained impairment in social interaction combined with restricted, repetitive, and stereotyped patterns of behavior, interests, and activities

  • No clinically significant delays in language acquisition, cognitive development, or self-help skills in first 3 years of life

  • It has not been determined if Asperger’s is qualitatively different from Autism

    • Some researchers believe it is

    • For now, they are distinct diagnoses


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DSM Criteria for PDD-NOS

  • Severe and pervasive impairment in the development of reciprocal social interaction along with

    • Communication skills OR

    • Presence of stereotyped behavior, interests, and activities

  • But criteria are not met for any other PDD


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Rett’s DisorderOccurs only among females and involves a pattern of head growth deceleration, MR, a loss of fine motor skill, and the presence of awkward gait and trunk movement.


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Childhood Disintegrative DisorderRare pattern of regression following at least two years of normal development producing stereotyped behaviors, loss of play, social, and communication skills


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Differential Diagnostic Features of PDDS

From Volkmar and Klin (2005)


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Diagnostic Criteria for Autistic Disorder

A total of six or more total characteristics from the following three categories (DETAILED ON SUBSEQUENT SLIDES)

Onset must be before age 3:

  • Qualitative impairment in social interaction (must have at least two characteristics)

  • Qualitative impairment in communication (must have at least one characteristic)

  • Restricted repetitive and stereotyped patterns of behavior, interests and activities (must have at least one characteristic)

Adapted from: Diagnostic and Statistical Manual, 4th Ed., APA, 1994


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I. Qualitative Impairment in Social Interaction

Must meet 2 of the following:

  • Marked impairment in the use of non-verbal behaviors such as eye contact, facial expression or gestures to regulate social interaction

  • Failure to develop appropriate peer relationships

  • Lack of spontaneous seeking to share enjoyment or interests (joint attention)

  • Lack of social/emotional reciprocity


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II. Qualitative Impairments in Communication

Must meet 1 of the following:

  • Delayed development or total lack of spoken language

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

  • Stereotypic and repetitive use of language

  • Lack of varied, spontaneous pretend or social play


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Restrictive Repetitive and Stereotyped Patterns of Behavior or Interests

Must meet 1 of the following:

  • Preoccupation with one or more stereotyped and restricted pattern of interest that is either abnormal in intensity or focus

  • Inflexible adherence to non-functional routines

  • Stereotyped and repetitive motor mannerisms

  • Persistent preoccupation with parts of objects


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Learning Characteristics of Children with Autism

  • Stimulus overselectivity

  • Difficulty responding to natural contingencies and social cues

  • Difficulty generalizing skills

  • May rely on rote memory

    • May memorize information rather than comprehend it

  • May demonstrate proficient performance on tasks demanding visual spatial judgment and pattern recognition

    • Splinter skills

  • Difficulty in all dimensions of language including expressive/receptive language


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Behavioral Characteristics of Children with Autism

  • Little or no eye contact

  • Does not respond to name

  • Tantrums easily

  • Odd hand and finger mannerisms

  • Lines up toys or objects

  • Does not play with toys

  • Prefers to be alone

  • Likes to spin self or objects

  • Displays self-injurious behaviors

  • Lacks normal fear

  • Displays hand flapping and/or toe walking

  • Rocks or bangs head

  • Arches back

  • Video


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Physiological Characteristics of Children with Autism

  • Large head circumference

  • Low muscle tone

  • Frequent ear infections

  • Difficulty sleeping or unusual sleep patterns

  • Frequent gastrointestinal issues (reflux, stomach pains, diarrhea, constipation)

  • Rigid preference for certain foods

  • Other co-morbid disorders (mental retardation, seizures, hyperactivity, immune dysfunction, anxiety, depression, OCD, etc.)


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Prevalence

  • The Individuals with Disabilities Education Act (IDEA) requires each state’s Department of Education and the U.S. Department of Education to record specific childhood disabilities, including autism, for each school year

  • Current Centers for Disease Control statistics peg the prevalence of all ASDs as 1/150 nationwide but 1/94 in NJ

  • Since 1992, autism prevalence has increased at an average of 22% each year in NJ


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Prevalence

  • Increase in prevalence may be due to

    • Increases in requests for service

    • Changes in diagnostic criteria

    • Increased assessment opportunities

    • Better awareness by pediatricians, teachers, parents

    • An actual increase in cases?


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Etiology Possibilities

  • Genetic (strongest evidence)

    • Genes controlling development of brain “circuitry” have been implicated; some are inherited genes while others are gene mutations

  • Prenatal/Perinatal complications

    • Maternal rubella increases likelihood of autism

  • Environmental

  • Psychogenic

    • “Refrigerator Mother”

    • Although this has been shown to be false quite some time ago, unfortunately, it is still mentioned.


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Etiology Possibilities

  • Immunizations?

    • Although controversial, current scientific data do not support any causal relationship between vaccinations and autism

    • Incidence rates of autism have continued to rise unabated even with the removal of thimerosal (mercury-based compound) from vaccines in a number of countries worldwide


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Why Does Autism Need Specialized Treatment?

  • Pervasive Developmental Disorder (PDD) implies that a child with autism is affected along multiple dimensions

    • (Unlike certain other single dimension problems: learning disability, communication disorder, emotional and behavioral disorders)


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Why Does Autism Need Specialized Treatment?

  • Learning deficits

    • Affects every aspect of child’s education and academics

  • Language disabilities

    • Articulation, expressive, receptive, spontaneous, conversation, non-contextual vocalizations

  • Behavioral disorders

    • Stereotypic behavior: motor, visual, tactile,

  • Compulsive behaviors

    • rigidity of routine, intolerant of change


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Why Does Autism Need Specialized Treatment?

  • Attention deficits

    • Lack of eye contact, unaware of danger

  • Emotional impairments

    • Non-contextual emotions, lack of self-concept

  • Social impairments

    • Eye contact, gestures, facial expression, greetings, awareness of other children, friendships,

  • Play skills deficits

    • Imaginative, pre-occupations with objects/activities, general content knowledge


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Why Does Autism Need Specialized Treatment?

  • Sleep disturbances

    • Going to sleep late, getting up early, getting up during the night

  • Toileting impairments

    • Lack of awareness of accidents

  • Eating disabilities

    • Texture, appearance, gustatory


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References

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).Washington, DC: Author.

  • Filipeck, P.A. (2005). Medical aspects of autism. In F.R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders: Vol 1. Diagnosis, development, neurobiology, and behavior (3rd ed., pp. 534-578). Hoboken, NJ: John Wiley & Sons.

  • Volkmar, F.R., & Klin, A. (2005). Issues in the classification of autism and related conditions. In F.R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders: Vol 1. Diagnosis, development, neurobiology, and behavior (3rd ed., pp. 5-41). Hoboken, NJ: John Wiley & Sons.

  • Wing, L. (2005). Problems of categorical classification systems. In F.R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders: Vol 1. Diagnosis, development, neurobiology, and behavior (3rd ed., pp. 583-605). Hoboken, NJ: John Wiley & Sons.


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