Autistic Disorder

1. Autistic Disorder

2. What is Autism? • Autism is a complex developmental disability that typically appears during the first three years of life. • It is the result of a neurological disorder that affects the normal functioning of the brain • It impacts development in the areas of social interaction and communication skills

3. What is Autism continued • Both children and adults with autism typically show difficulties in: • Verbal and non-verbal communication • Social interactions • And leisure or play activities • Autism is a spectrum disorder that affects each individual differently at varying degrees.

4. What is Autism continued • Thus, that is why early diagnosis of Autism is imperative • Autism is one of five disorders that falls under the umbrella of Pervasive Developmental Disorder (PDD). • PDD is a category of neurological disorder that is characterized by “severe and pervasive impairment in several areas of development.”

5. Signs and Symptoms of Autism • As mentioned previously, autism is a spectrum disorder, and although it’s defined by a certain set of behaviors, children and adults with autism can exhibit any combination of these behaviors in any degree of severity. • Two children, both with the same diagnosis, can act completely different from one another and have varying capabilities.

6. Signs and symptoms continued • You may hear different terms used to describe children within this spectrum such as: • Autistic-like • Autistic tendencies • Autism spectrum • High-functioning or low-functioning autism • More-able or less-able

7. Signs and symptoms continued • More important than the term used to describe autism is understanding that whatever the diagnosis, children with autism can learn and function normally and show improvement with appropriate treatment and education • Every person with autism is an individual and like all individuals has a unique personality and combination of characteristics

8. Signs and symptoms continued Behavioral Indicators of Autism in Children: • Language/Communication • Rarely initiates communication • Uses little or no speech or is overly verbal • Uses unusual vocal intonation/rhythm • Understands and uses words literally • Relating-to people • Doesn’t communicate with eyes • Seems content when left alone • Seeks social contact in unusual ways • Eye contact is limited and fleeting

9. Signs and symptoms continued • Relating-to the environment • Is upset or resists change • Drifts about aimlessly • Play is repetitive • Exhibits intense and obsessive interests • Responses to Stimuli • Sometimes seems deaf • Exhibits panic related to specific sounds • Flicks fingers before eyes • Pulls away when touched

10. Signs and symptoms continued • Developmental Discrepancies: • Skills are either very good or very delayed and the child learns skills out of the normal sequences, for example: • Reads but doesn’t understand the meaning • Is very good with puzzles and pegs, but is very poor with following instructions • Draws detailed pictures but can’t button coat

11. Signs and symptoms continued • DSM-IV Criteria, Pervasive Developmental Disorders: • A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3): • (1) qualitative impairment in social interaction, as manifested by at least two of the following: • (a) marked impairment in the use of multiple nonverbal behaviors, such as eye-to- eye gaze, facial expression, body postures, and gestures to regulate social interaction • (b) failure to develop peer relationships appropriate to developmental level • (c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) • (d) lack of social or emotional reciprocity

12. Signs and Symptoms continued • (2) qualitative impairments in communication, as manifested by at least one of the following: • (a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) • (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others • (c) stereotyped and repetitive use of language or idiosyncratic language • (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

13. Signs and symptoms continued • (3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following: • (a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus • (b) apparently inflexible adherence to specific, nonfunctional routines or rituals • (c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movements) • (d) persistent preoccupation with parts of objects

14. Signs and symptoms continued • B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play. • C. The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.

15. Epidemiology • Reported rates range from .02%-.06% • Much more common in boys than girls: 4:1 ratio. • More severe in females. • Can be identified in infancy, though most diagnoses occur around 3-5 years of age. • Equally prevalent in all SES, race/ethnicity, all over the world.

16. Autistic Savants • Autistic child showing unreal ability in a skill or set of skills. Called splinter skills. • Complex math, Music composition, Calendar memorization, Counting. • Not understood; savants still show up as mentally retarded on traditional IQ tests. • Less than 5% of all autistic individuals are savants. (that’s 1 in 40,000)

17. Comorbidity • Mental retardation is the most common disorder comorbid with autistic disorder • Up to 70% of individuals with autism meet the criteria for mental retardation • About 57%-70% with autism have an IQ lower than 50, 25% have an IQ between 70-90, and the remaining 5% are of average intelligence. • Autism can also co-occur with many other conditions and syndromes such as hearing and vision impairments, cerebral palsy, Down Syndrome, and seizure disorders.

18. Etiology of Autism • Autism is a syndrome with many possible causes. Anything that makes the central nervous system develop abnormally, either before or after birth can cause autism. • In most cases what triggers the developmental differences occur early in the period of fetal development. • It is vital to note that autism is not caused by parental rejection, lack of love, or inadequate parenting skills.

19. Etiology continued • There is no single cause for autism, but it’s generally accepted by the medical community that it’s caused by abnormalities in brain structure or function. • Researchers are investigating a number of theories, including the link between heredity, genetics and medical problems.

20. Etiology continued • Some of the conditions implicated as cause: • Viral infections: • Such as congenital rubella • Herpes simplex infection • Metabolic Imbalances: • Such as thyroid disease • Exposure to Alcohol and drugs: • Cocaine-addicted babies and fetal alcohol syndrome • Exposure to environmental chemicals: • Such as lead and other toxic chemicals

21. Etiology Continued • Genetic-chromosomal factors: • Some families have more than one child with autism or other developmental disorders. Fragile-X and Down Syndrome are both genetic disorders that co-occur with autism. • Oxygen Deprivation/over exposure during/shortly after birth: • As in retinopathy or premature birth • After severe viral infections and traumatic brain therapy: • As in encephalitis, spinal meningitis, or brain injury from a fall or severe car accident. In these situations, symptoms of autism will occur after normal age of onset.

22. Treatment of Autism • Children do not “outgrow” autism, but symptoms may lessen as the child develops and receives treatment. • While there is no one behavioral or communications test that can detect autism, several screening instruments have been developed that are now being used in diagnosing autism.

23. Treatment continued • Some of these screening instruments are: • CARS rating system (Childhood Autism Rating Scale), that is based on observed behavior. A 15-point scale is used to evaluate a child’s relationships, body use, listening response, and verbal communication. • CHAT (Checklist for Autism in Toddlers), is used for screening at 18 months of age. This screening tool uses a short questionnaire with two sections, one prepared by the parents, the other by the family doctor. • Autism Screening Questionnaire, which is a 40 item screening scale for children 4 and older to help evaluate communication skills and social functioning.

24. Treatment continued • When treating autism it requires a multidisciplinary assessment team that consists of all or some of the following: • Developmental pediatrician who treats health problems. • Child psychiatrist to be involved in the initial diagnosis. • Clinical psychologist who specializes in understanding the nature and impact of developmental disabilities. • Occupational therapist who focuses on practical, self-help skills that will aid in daily living. • Physical therapist who helps improve the use of bones, muscles, joints, and nerves to develop coordination and motor skills. • Speech/language therapist who is involved in the improvement of communication skills, including speech and language. • Social worker that provides counseling services or acts as a case manager.

25. Treatment continued • With appropriate services, training, and information, children with autism will grown and can learn, even if at the different developmental rates than others. • While there is no cure for autism, there are treatment and education approaches that may reduce some of the challenges associated with the disability. • Intervention may help to lessen disruptive behaviors, and education can teach self-help skills that allow for greater independence. But treatment must be tailored to the child’s individual behaviors and needs.

26. Treatment continued • It is important to match your child’s needs and potential with treatments or strategies that are likely to be effective in moving him/her closer to normal functioning. • Treatment approaches are evolving as more is learned about autism. There are many therapeutic programs, both conventional and complementary, that focus on replacing dysfunctional behaviors and developing skills. • It is vital not to rush your child because he/she might have already learned to cope with his or her current environment and those changes could be more harm then help.

27. Education • Just as there are various treatment approaches, there are multiple educational programs that provide good learning environments. • Educational planning for students with autism will often address a wide range of skill development, including academics, communication, and language/social/self-help skills. • Most professionals agree that individuals with autism respond well to highly structured, specialized education programs designed to meet the individuals needs.

28. Education continued • There are areas that are important to look at when creating a plan: social skill development, communication, behavior, and sensory integration. • Academic goals need to be tailored to the individual’s intellectual ability and functioning level. • It is important to note that no one program or diet is perfect for every person or child with autism. Several approaches should be looked at before settling on a specific approach.