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5. Just In: Aspergers Prevalence Predicted To Fall To Zero PHARMA & HEALTHCARE 12/04/2012

6. Classic Autism A child labeled today as having an Autism Spectrum Disorder may look very different from the child diagnosed 30 years ago with Autism. At that time we diagnosed children who more closely resembled the children first described by Dr. Leo Kanner, in the seminal paper, Kanner, L. (1943), Autistic Disturbances of Affective Contact, Nervous Child2, pp.217-250.

7. Types of Autism Spectrum Disorders/ Pervasive Developmental Disorders • Autistic Disorder • Asperger’s Disorder • Rett’s Disorder • Childhood Disintegrative Disorder • Pervasive Developmental Disorder- Not otherwise specified

8. Asperger’s Disorder • Impairments in social interaction • Problems with nonverbal social interactions such as eye gaze, facial expression, gestures and/or body posture • Problems with peer relationships and an inability to form peer relationships appropriate to his/her age • Problems with shared pleasure or enjoyment and a failure to seek such interaction with other people. (For example not pointing out interesting objects or not bringing a toy or object to an adult to share in the interest.) • Problems with normal give-and-take of social interactions like taking turns or expressing emotions when socially appropriate

9. Autism Spectrum Disorders Persistent deficits • Social communication/ interaction • Restricted, repetitive pattern of behavior, interests, activities Present, early developmental period; may manifest later Impairment, assess each deficit separately Severity (each deficit) • Requiring support, requiring substantial support, requiring very substantial support Specifiers • With/ without accompanying intellectual impairment • With/ without accompanying language impairment • Associated with known medical or genetic condition or environmental factor • Associated with another neurodevelopmental, mental, or behavioral disorder • With catatonia

10. Communication Disorders Social (Pragmatic) Communication Disorder Persistent difficulties – social use of verbal & nonverbal communication • Social • Change with context/ listener • Rules of conversation/ story-telling • Non explicit Functional limitations Onset, early developmental period

11. Changes Consolidation of all variants into 1 disorder Specifiers to indicate specific characteristics

14. J Am Acad Child Adolesc Psychiatry. 2012 Apr;51(4):368-83. doi: 10.1016/j.jaac.2012.01.007. Epub 2012 Mar 14.Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder.McPartland JC, Reichow B, Volkmar FR.

15. Asperger - 1944 “Autistic Psychopathy” • Series of cases – all male • Marked social problems • Good cognitive/language skills • Motor problems • Circumscribed interests • Positive family hx (esp. fathers)

16. Asperger: 1944 • Unusual circumscribed interests • - all absorbing, interfered with functioning • - family life would revolve around these • Motor Skills - Often clumsy - poor body awareness

17. Asperger: 1944 • Social Disability • couldn’t join groups • lack of friends even though interested in others • intellectualization of affect • conduct problems (noncompliant/negativistic) • Communication Problems • verbosity, one sided style • impaired nonverbal skills • idiosyncratic communication • “little professors”

18. Asperger Syndrome 1944 - 1981 • Limited Interest until early 1980’s • - Van Krevelen in 1970’s – emphasized personality trait • Wing (1981) synthesis and case series • modifications in Asperger’s description • some features • - mild MR • possible language problems • possible continuity with autism • case reports

19. Asperger’s 1981 - 1994 • Lack of consistent criteria • - markedly different views of the syndrome developed • Issue of risk psychosis/violence • Comparisons to Autism

20. Other Diagnostic Constructs • From Neuropsychology • - Nonverbal Learning Disabilities (NLD) • From Neurology • - Right Hemisphere Syndromes • - Developmental Disabilities of the Right Hemisphere • From Psycholinguistics • - Semantic-Pragmatic Disorder • Also • - “Hyperplexia”, Schizoid Personality in Childhood, • OC Behaviors, . . .

21. Asperger’sSyndrome Inconsistencies in Use Issues with lack of consensual criteria • AS = higher functioning autism (without MR) • AS = adults with autism • AS = PDD-NOS/ “mild autism” • AS = shyness/ “nerds” (shades into normalcy) • AS = complex profiles associated with social problems • AS = distinctive disorder

22. Autism Spectrum Disorders Persistent deficits • Social communication/ interaction • Restricted, repetitive pattern of behavior, interests, activities Present, early developmental period; may manifest later Impairment, assess each deficit separately Severity (each deficit) • Requiring support, requiring substantial support, requiring very substantial support Specifiers • With/ without accompanying intellectual impairment • With/ without accompanying language impairment • Associated with known medical or genetic condition or environmental factor • Associated with another neurodevelopmental, mental, or behavioral disorder • With catatonia

23. Communication Disorders Social (Pragmatic) Communication Disorder Persistent difficulties – social use of verbal & nonverbal communication • Social • Change with context/ listener • Rules of conversation/ story-telling • Non explicit Functional limitations Onset, early developmental period

24. Depression A particularly common problem in adolescents/adults • Growing awareness may risk for depression • ? Genetic vulnerability • Drug Treatments • - Importance of careful diagnosis (difficulties in dx) • - Track changes over time in mood and symptoms • - Agents: SRIs, tricycle antidepressants • - Need for appropriate monitoring, keep in mind time • course and potential side effects

25. Anxiety • Risk for anxiety problems • - Origins unclear - social limitations? Intrinsic? • - Frequent victimization, difficulties in dealing with • transitions, lack of empathy yet sufficient ability to • realize that they are not “ getting it” • Various agents available • - SSRIs • -minor tranquilizers, buspirone • - alpha-adrenergic agonist medications • - issues of disinhibition

26. Anxiety • Risk for anxiety problems • - Origins unclear - social limitations? Intrinsic? • - Frequent victimization, difficulties in dealing with • transitions, lack of empathy yet sufficient ability to • realize that they are not “ getting it” • Various agents available • - SSRIs • -minor tranquilizers, buspirone • - alpha-adrenergic agonist medications • - issues of disinhibition

27. Goals for Education Academic Curriculum Don’t loose sight of the big picture • Long-term goals • - each item evaluated in terms of benefits for • socialization, vocational potential, and quality of life • - avoid curriculum inflexibility (i.e. strict adherence • to credit system) • - curriculum modification: the concept of “secondary gains” • Emphasis on strengths that may serve vocational goals • Mentorship, specific projects • Foster motivation, self-initiative, and positive self-concept