Overview • What is Autism? • Is there more than one type of Autism? • What causes Autism? • How is Autism diagnosed? • What are the characteristics of Autism? • What are the most effective approaches to treating Autism? Is there a cure?
WHAT IS AUTISM? • Very complex, often baffling developmental disability • First described by Leo Kanner in 1943 as early infantile autism • “Auto” – children are “locked within themselves.” • For next 30 years, considered to be an emotional disturbance
WHAT IS AUTISM? • Today, autism is a severe form of a broader group of disorders • These are referred to as pervasive developmental disorders • Typically appears during the first 3 years of life
WHAT IS AUTISM? • Very likely neurological in origin – not emotional, not the refrigerator mom • Prevalence figures vary widely earlier: 5/10,000, but recent data say as high as 1/1000 or even 1/500. • 4 times more prevalent in boys • No known racial, ethnic, or social boundaries • No relation to family income, lifestyle
WHAT IS AUTISM? • Autism impacts normal development of the brain in areas of social interaction and communication skills. • Difficult to communicate with others and relate to the outside world. • Occasionally, aggressive and/or self-injurious behavior may be present.
WHAT IS AUTISM? • May exhibit repeated body movements (hand flapping, rocking). • Unusual responses to people • Attachment to objects • Resistance to change in routine • Sensory sensitivities
WHAT ARE THE TYPES? • Actually, the “umbrella” heading is Pervasive Developmental Disorder (PDD). • Autism is one of the 5 PDDs. • All have commonalities in communication and social deficits • Differ in terms of severity
1. Autistic Disorder • Impairments in social interaction, communication, and imaginative play. • Apparent before age 3. • Also includes stereotyped behaviors, interests, and activities
2. Asperger’s Disorder • Impairments in social interactions, and presence of restricted interests and activities • No clinically significant general delay in language • Average to above average intelligence
3. Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) • Often referred to as atypical autism • Used when a child does not meet the criteria for a specific diagnosis, but there is severe and pervasive impairment in specified behaviors
4. Rett’s Disorder • Progressive disorder which, to date, has only occurred in girls. • Period of normal development and then the loss of previously acquired skills • Also loss of purposeful use of hands, which is replaced by repetitive hand movements • Beginning at age of 1-4 years
5. Childhood Disintegrative Disorder • Normal development for at least the first 2 years • Then significant loss of previously acquired skills
Conclusions on Types • Autism is a spectrum disorder • This means that symptoms and characteristics can present themselves in wide variety of combinations, from mild to severe • Autistic individuals can be very different from each other • “Autism” is still commonly used to refer to any of the 5 PDDs
What causes (and doesn’t cause) autism? • Good agreement in general that autism is caused by abnormalities in brain development, neurochemistry and genetic factors • Some of the research indicates a variety of things including: Exposure to heavy metals Environmental issues Lyme Disease, etc. • Yet there is no proof that any one of these areas is truly responsible for Autism. • Another scenario is that there have always been many children with Autism, but the diagnosis hasn't been there like it is now. • Bettlelheim’s theory of psychogenesis?
How is Autism Diagnosed? • No definitive medical test • Team uses interviews, observation, and specific checklists developed for this purpose. • Team might include neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, etc. • Must rule out MR, hearing impairment, behavior disorders, or eccentric habits
CHARACTERISTICS • 1. Communication/Language • 2. Social Interaction • 3. Behaviors • 4. Sensory and movement disorders • 5. Resistance to change (predictability) • 6. Intellectual functioning
1. Communication/language • Broad range of abilities, from no verbal communication to quite complex skills • Two common impairments: • A. Delayed language • B. Echolalia
A. Delayed language • 50% of autistic individuals will eventually have useful speech (?) • Pronoun reversal: “You want white icing on chocolate cake.” • Difficulty in conversing easily with others • Difficulty in shifting topics • Look away; poor eye contact • Facilitated communication?
Elements of Facilitated Communication • 1. Physical Support • 2. Initial training/introduction • 3. Maintaining focus • 4. Avoiding competence testing • 5. Generalization • 6. Fading
B. Echolalia • Involuntary parrot-like repetition (echoing) of a word or phrase just spoken by another person. • Common in very young children (Age 3) • Immediate or delayed • Is there communicative intent with echolalia?
2. Social Interaction • One of hallmarks of autism is lack of social interaction • 1. Impaired use of nonverbal behavior • 2. Lack of peer relationships • 3. Failure to spontaneously share enjoyment, interests, etc. with others • 4. Lack of reciprocity Theory of mind?
3. Behaviors • Repetitive behaviors, including obsessions, tics, and perseveration • Impeding behaviors (impede their learning or the learning of others) • Will need positive behavior supports • A. Self-injurious behavior • B. Aggression
4. Sensory and movement disorders • Very common • Over- or under-sensitive to sensory stimuli • Abnormal posture and movements of the face, head, trunk, and limbs • Abnormal eye movements • Repeated gestures and mannerisms • Movement disorders can be detected very early – perhaps at birth
5. Predictability • Change in routine is very stressful • May insist on particular furniture arrangement, food at meals, TV shows • Symmetry is often important • Interventions need to focus on preparing students for change if possible
6. Intellectual functioning • Autism occurs in children of all levels of intelligence, from those who are gifted to those who have mental retardation • In general, majority of individuals with autism are also identified as having mental retardation – 75% below 70 • Verbal and reasoning skills are difficult • Savant syndrome
Interventions • 1. Individualization and early intervention are the keys • 2. Include life skills, functional academics, and vocational preparation • 3. Positive behavior support • 4. Social stories (music therapy?) • 5. *Lovaas model *Behavioral intervention program developed in the Psychology Department of UCLA under the direction of Dr. O. Ivar Lovaas.
Facts and Statistics • 1 in 150 births<1>Only 20 years ago the statistics were 1 in 10,000. • 4:1 ratio of boys to girls • 1 in 98 boys • 1 to 1.5 million Americans<2> • Fastest-growing developmental disability10 - 17 % annual growth • $90 billion annual cost<3> • 90% of costs are in adult services<3> • Cost lifelong care can be reduced by 2/3 w/ early diagnosis/intervention<3> • In 10 years, the annual cost will be $200-400 billion<4> • 1.Based on prevalence statistics from the Centers for Disease Control and Prevention (2007). • 2.Based on the autism prevalence rate of 2 to 6 per 1,000 (Centers for Disease Control and Prevention, 2001) and 2000 U.S. Census figure of 280 million Americans. • 3.Jarbrink K, Knapp M, 2001, London School of Economics study: "The economic impact on autism in Britain," 5 (1): 7-22. • 4.ASA calculates that the annual cost of autism will increase to $200-400 billion in 10 years. February 2003 There are more than 500,000 individuals under the age of 21 with some form of Autism right now in the United States.
Facts and Statistics cont. • More children will be diagnosed with autism this year than cancer, diabetes, Downs Syndrome and AIDS combined. • Autism receives less than 5% of the research funding of most of the more prevalent childhood disorders. • Incidence vs. Private Funding (2007) • ConditionIncidencePrivate Funding Pediatric AIDS 1 in 8,000 394 Million Leukemia 1 in 25,000 310 Million Muscular Dystrophy 1 in 20,000 175 Million Juvenile Diabetes 1 in 500 130 Million Autism 1 in 150 42 Million
Autism Organizations • Oregon: • Autism Society of Oregon • USA: • Asperger and Autism Information by MAAP Services • Autism National Committee (AUTCOM/ANC) • Autism Network International (ANI) • Autism Society of America • Autism Speaks • Center for the Study of Autism • Families for Early Autism Treatment (FEAT) of Northern California • Society for Auditory Integration Training