Autism Spectrum Disorders: An Introduction Rhea Paul, Ph.D., CCC-SLP

1. Autism Spectrum Disorders: An Introduction Rhea Paul, Ph.D., CCC-SLP Southern Connecticut State University Yale Child Study Center Feb. 11-15, 2008 rhea.paul@yale.edu www.autism.fm

3. Another Way to Look at it

4. Autistic Disorder • Impairment in social interaction-at least 2 of: • Gaze, facial expression, gesture impairments • Failure to develop peer relationships • Lack of seeking to share with others • Lack of reciprocity • Impairment in communication-at least 1 of: • Delay in language • Impairment in conversation ability • Stereotyped and repetitive langauge • Lack of pretend play • Restricted, repetitive stereotyped behavior, interests, activities-at least 2 of: • Preoccupations with abnormal focus or intensity • Rigid need for routine or ritual • Motor mannerisms • Preoccupation with parts of objects Onset before age 3

5. Autistic Disorder- 3 Examples • http://www.youtube.com/watch?v=kSB_BQgOEx0&feature=related

6. Asperger Syndrome in DSM-IV • Impairment in social interactionn (same as autism) • Restricted, repetitive stereotyped behavior, interests • No clinically significant general delay (CSD) in language • No CSD in cognitive, self-help, or adaptive skills

7. Asperger Syndromehttp://www.youtube.com/watch?v=Zu4z-ZKZZo4&feature=related

8. Rett Syndrome, 1966 • Normal early development in girls • Head growth deceleration • Loss of purposeful hand movements • Development of "autistic-like" features • Characteristic course • Other unusual Behaviors: • aerophagia • tongue pulling • Medical problems: • Scoliosis • movement problems

9. Rett Syndrome Video Sample http://www.youtube.com/watch?v=ZBsEwg_yuDQ&feature=related

10. Childhood Disintegrative DisorderHeller, 1908 • Period of Normal Development (years) • Usually seen in males • Marked Regression (multiple areas) • Sometimes CNS insult • Usually minimal recovery • Usually as severe or more severe than classic autism • Usually poor long-term prognosis

11. PDD-NOS • Atypical autism • More prevalent than classic autism • Are there subgroups/types? • DSM-IV: severe, pervasive impairment in reciprocal social interaction AND in EITHER: • Verbal or nonverbal communication • Restricted, repetitive stereotyped behavior, interests, or activities

12. PDD-NOS • JK

13. PDDs in DSM-IV • Always associated with MR • Childhood Disintegrative Disorder or Heller’s syndrome • Rett’s Syndrome • May or may not be associated with MR • Autism • Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) • Usually not associated with MR • Asperger Syndrome (AS) • High Functioning Autism (HFA)

14. Cognition 75% of people with ASD function in the MR Range • Considerations • Appropriate test • Stability of scores • Scatter is common • Islets of ability • "autistic savants” • Improvement withearly intervention

15. Savant Abilities or Splinter Skills Drawing: Nadia, Age 3

16. Drawing Stephen Wiltshire

17. Musical Ability Blind Tom

18. Calculation Calendar Mathematics

19. Etiology of Autism • Early focus on parents • Psychodynamic views, Kanner, Bettleheim • BUT evidence against • No abnormalities in child care • No major personality problems • No obvious deficits in parenting • By 1970's a large body of evidence favoring neurobiological etiology

20. Prevalence • Used to be thought rare • Current estimates: • Autism: 1/1000 - 2/10,000 • Is the frequency of autism increasing? • Rett=s and CDD very rare - ? 1/15,000 • Asperger=s - ? 1/7,000 • PDD-NOS - ? 1/200

21. Is the incidence increasing? • No question that more cases are being identified but is there a ‘real’ increase? • Changes in definition • Better diagnosis at both ‘ends’ of the spectrum • Growing awareness of the condition • Educational implications of label (for services) • Diagnostic substitution

22. Do vaccines cause autism? • Several large, international epidemiological studies refute association • children get vaccines at 18 mo.; ASD often becomes obvious at this age • Autism rates in Japan continued to rise after the withdrawal of MMR vaccine. • Honda et al. No effect of MMR withdrawal on the incidence of autism: a total population study. Journal of Child Psychology and Psychiatry 2005 • Mercury additives said to be cause were removed BEFORE increases in prevalence were seen • Children should be vaccinated; danger of not vaccinating is greater than dangers of inoculation.

24. Genetics of Autism • Early impression - no genetics • But condition rare, cases don=t usually reproduce • Subsequent research: • risk in identical twins • rate in sibs (2%) • associated problems in sibs

25. Functional Classification • High Functioning • Includes HFA, AS, and PDD-NOS • IQ within or near normal range • but adaptive behavior much lower • Fluent, functional language by age 6 • Low Functioning • Includes Autism, PDD-NOS, Rett syndrome, CDD • IQ and adaptive behavior significantly low (<70) • No speech, or small single word/sign vocabulary with a few phrases, mostly rote or echolalic

26. Developmental Changes • Preschool: most "classic" autistic features • Sometimes not all features are exhibited until age 3 • Some children respond dramatically to intervention • School age: social interest & behavior problems • Adolescence: • gains & losses, seizures onset • Adulthood: • About 1/3rd have some degree of independence • Many individuals require high levels of support

27. Predictors of Outcome in Autism • Presence of communicative speech by age 6 • Outcome worse if child is mute or has speech which is not really used for communication • Nonverbal IQ in the normal range • Less classic cases (PDD-NOS) = better outcome • Seizures are more common with lower IQ

28. Outcomes in autism • 1-2% of cases achieve normal outcome • Live independently and hold down job • 1/3 have some degree of independence • 2/3 require high levels of support • Reports of cures should be viewed with caution • BUT Future outcomes may improve due to • Earlier detection • Better and more sustained intervention • Mandates for service

29. Adult Outcome: 1981 vs. 1994 • Limitations of available data • DeMyer, et al., 1981 • Goode, Rutter, & Howlin, 1994

30. Autism: Shades of Difference Video • http://abcnews.go.com/Video/playerIndex?id=2286327 • http://www.autismspeaks.org/video/glossary.php