AAA Section 03 Autism Spectrum Disorder Ver 03 2013
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AAA Section 03 Autism Spectrum Disorder Ver 03 2013 AAA Section 03 Autism Spectrum Disorder Ver 03 2013 Presentation Transcript

  • Autism Spectrum Disorder UNDERGRADUATE Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 1 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Introduction to the Section.• What is Autism & DSM-V change?• Symptoms of autism. UNDERGRADUATE• Prevalence of autism.• How Autism was first recognised.• Assessment.• Diagnosis.• Questions. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 2 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Learning Outcomes of this Section.On completion of the Section and with independent study you should be able to: UNDERGRADUATE1. Understand the main symptoms, variations and diagnostic criteria relating to autistic disorder.2. Be able to describe autistic disorder in detail. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 3 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Autism Spectrum Disorder.A continuum that…“…ranges from the most profoundly UNDERGRADUATE physically and mentally retarded person ... to the most able, highly intelligent person with social impairment in its subtlest form as his only disability. It overlaps with learning disabilities and shades into eccentric normality.” The Autistic Spectrum (2003) Lorna Wing Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 4 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Autism No single cause; no single cure. UNDERGRADUATE Hence: A spectrum, a continuum, a syndrome.Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 5Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • What Is Autism?• Autism is a developmental disability that significantly affects a person’s verbal and nonverbal UNDERGRADUATE communication, social interactions, and education performance. It is generally evident before age 3.• Characteristics include engagement in repetitive activities & stereotyped movements, resistance to environmental change or changes in daily routines, & unusual responses to sensory experiences. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 6 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • What Is Autism?• Considered a continuum whereby it can be UNDERGRADUATE found with various degrees of impairment and functioning (Wing & Gould, 1979).• The probability of a second child being diagnosed with ASD is 1 in 20.• A life-long pervasive developmental disorder with genetic susceptibility. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 7 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • What Is Autism?• A syndrome – cluster of symptoms appearing in a particular combination (Boucher & Pennington, 1991). UNDERGRADUATE• A spectrum of disorders. Ranges from low functioning – high functioning / Aspergers Disorder (Aspergers Syndrome).• Presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 8 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • What Is Autism (under DSM-IV)?The DSM-IV includes five types of disorder under the term ‘Pervasive Developmental Disorder’ UNDERGRADUATE PDD. 1) Autistic Disorder*. 2) Rett’s Disorder. 3) Childhood Disintegrative Disorder. 4) Asperger’s Disorder*. 5) Pervasive Development Disorder Not Otherwise Specified*.* Mainly these form the Autistic spectrum ASD. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 9 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • What Is Autism (under DSM-V)?The major change to the diagnosis of autism is theuse of the umbrella term of ‘Autism SpectrumDisorder’. [from May 2013] UNDERGRADUATEThe DSM-V will combine the currently separatediagnoses of Autistic Disorder, Aspergers Disorder,Pervasive Developmental Disorder-not otherwisespecified (PDD-NOS) and Childhood DisintegrativeDisorder.The age of onset will be moreflexible, allowing for older childrento be diagnosed. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 10 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • What Is Autism?“There are no clearly established guidelines for measuring the severity of a persons symptoms. Therefore, the line between Autism and PDDNOS is blurry.” (Boyle, 1995). UNDERGRADUATEOther features often present:• An insistence on sameness.• Attentional and perceptual abnormalities – notice fine details and very small changes in their environment.• Difficulties generalising learning to new situations.• Can have exceptional talents and abilities (savant abilities). Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 11 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • What Is Autism? Impairment in social interaction.Impairment in verbal Restricted, repetitive and and non verbal stereotyped patterns of communication. behaviour.• The so-called ‘triad of impairment’ summarises the difficulties of the autistic child but the actual manifestation of these can vary.
  • The Triad Of Impairment.1. Impairment in social interaction. UNDERGRADUATE• Difficulties in making sense of the world can lead to behaviour that appears bizarre and antisocial.• May withdraw totally or may attempt to interact but may upset, bore or irritate others.• Problems in forming relationships. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 13 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • The Triad Of Impairment.2. Impairment in verbal and non verbal communication. UNDERGRADUATE• Difficulties in receptive language – may take everything literally.• Difficulties with metaphor.• Difficulties with pragmatics - don’t easily understand facial expressions, tone of voice, gesture (Happè, 1993; Tager-Flusberg, 2001). Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 14 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • The Triad Of Impairment.3. Restricted, repetitive and stereotyped patterns of behaviour. UNDERGRADUATE• Find change very difficult.• Often develop obsessive interests.• Rigid and restricted behavioural patterns – very set in their routines (Happè, 1993).• Restricted repertoire of interests. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 15 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • What Does Autism Look Like?• Poor eye contact.• Doesnt seem to know how to play with UNDERGRADUATE toys.• Excessively lines up toys or other objects.• Is attached to one particular toy or object.• Doesnt smile.• At times seems to be hearing impaired. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 16 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • What Does Autism Sound Like?• The child doesn’t point, make baby babble or gestures by one year of age. UNDERGRADUATE• Usually the child doesn’t speak one word by 16 months of age (however, some have language and lose it around 2 years of age.).• Does not combine two words by 2 years of age.• Does not respond to name when called.• Loses language or social skills. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 17 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • What Does Autism Feel Like?• Hypersensitive to sounds: – Imagine chairs sliding on the floor, keys on a keyboard clicking, someone chewing, a fly buzzing outside the UNDERGRADUATE window all coming at you at one time.• Has a routine and feels lost if the routine is changed.• Hypersensitive to touch.• Hypersensitive to light.• Takes language literally: – If a police officer says “freeze” the person with autism thinks: that’s silly…it’s not freezing.• Thinks in pictures. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 18 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Prevalence Of Autism.• Went from 1 in 2500, to 1 in 1000, to 1 in 166 over the past decade.• Autism is now more common than childhood UNDERGRADUATE cancer, Down’s syndrome, spina bifida or cystic fibrosis.• Boys are affected 4 times as often as girls but unknown as to why.• 1 out of 68 families will have a child with autism.• Growing at a rate of 10-17 percent per year (it is thought). Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 19 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Prevalence Of Autism. Prevalence of Autism. UNDERGRADUATENumber of cases per 10,000 80 p l o 60 n j m 40 i k h 20 a c d g e f 0 b 1965 1970 1975 1980 1985 1990 1995 2000 2005 Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 20 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Increasing Incidence Of Autism?"Autism is not a modern problem, even though it has only been recognised in modern times. In view of the short UNDERGRADUATE history of psychiatry, and the even shorter history of child psychiatry, we know that a disorder recently described is not necessarily a recent disorder. An increase in diagnosed cases does not necessarily mean an increase in cases." Autism: Explaining the Enigma (1989) by Uta Frith. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 21 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Increasing Incidence Of Autism?• Science still baffled over its aetiology (genetic origin). UNDERGRADUATE• Diagnosis has been purely behaviourally bases.• New criteria for diagnosis may account for the apparent increase in its prevalence.• Currently estimates vary wildly. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 22 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • How Autism was First Recognised. UNDERGRADUATE• Leo Kanner and Hans Asperger who, independently of each other, published accounts of this disorder.• These publications, Kanners in 1943 and Asperger’s in 1944, contained detailed case descriptions and also offered the first theoretical attempts to explain the disorder. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 23 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • How Autism was First Recognised.• Both authorities (Leo Kanner and Hans Asperger) believed that there was present from birth a fundamental disturbance which gave rise to highly UNDERGRADUATE characteristic problems.• Kanner, working in Baltimore, and Asperger, working in Vienna, saw cases of strange children who has in common some fascinating features.• Above all the children seemed to be unable to entertain normal affective relationships with people. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 24 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • How Autism was First Recognised.• Kanner’s paper has become the most quoted in the whole literature on autism.• Asperger’s paper, written in German, and published during the second world war, was UNDERGRADUATE largely ignored.• Asperger’s definition of autism or, as he called it, ‘autistic psychopathy’ is far wider than Kanners.• Having this special category has proved clinically useful.• The belief has grown that Asperger described quite a different type of child, not to be confused with the one Kanner described. This is not the case. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 25 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • How Autism was First Recognised.• Both Kanner and Asperger choose the word ‘autistic in order to characterise UNDERGRADUATE the nature of the underlying disturbance.• In fact, it is not really a coincidence, since the label had already been introduced by the eminent psychiatrist Eugen Bleuler in 1911. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 26 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • How Autism was First Recognised.• In the 70s, knowledge of Autism begun to spread to Sweden. The first autistic classes within special UNDERGRADUATE education were started in the middle of the 70s.• The work of Asperger did not become known until the end of the 1980s when his book was translated into English.• Kanners work and Bettelheims ‘refrigerator mother’ theory of autism were quite often confused and it was generally accepted that autistic children had frigid mothers. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 27 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Assessment & Diagnosis.• Assessed on a behavioural basis.• ICD-10 (11th edition, due in 2015) and DSM-IV (shortly DSM-V); tick-list medical approach. UNDERGRADUATE• Missed diagnosis and misdiagnosis. – Multiple referral routes. – Pressures on LEA resources. – Multiple assessment protocols.• There’s also pressure NOT to diagnose (limited resources at Local Authority level). Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 28 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Assessment & Diagnosis.The NICHD lists these five behaviours that signal further evaluation is warranted: UNDERGRADUATE – Does not babble or ‘coo’ by 12 months. – Does not gesture (point, wave, grasp) by 12 months. – Does not say single words by 16 months. – Does not say two-word phrases on his or her own by 24 months. – Has any loss of any language or social skill at any age. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 29 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Assessment & Diagnosis.• Assessment for the purpose of diagnosis typically occurs in clinics or private practices and is led by UNDERGRADUATE psychiatrists, psychologists, or physicians. – CARS rating system (Childhood Autism Rating Scale). – The Checklist for Autism in Toddlers (CHAT). – The Autism Screening Questionnaire. – The Screening Test for Autism in Two-year Olds. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 30 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Assessment & Diagnosis.• Thorough assessment depends on information gathered through a variety of methods. – Professionals. UNDERGRADUATE – Family members. – Educators.• There is not a single test that when used alone can provide a definitive diagnosis of an autism spectrum disorder. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 31 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Assessment & Diagnosis.• It’s easier to ‘spot’ autism at the low functioning end of the spectrum. UNDERGRADUATE• High functioning children do adapt .• Early intervention is critical. – Younger children have a greater degree of brain plasticity (Edelman, 1992).• Late screening: – Very few tools sensitive to adolescent/adult diagnosis. – Self-diagnosis common (AQ published on web). Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 32 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33
  • Is There A Cure For Autism?• No – it is a lifelong disorder. – Some suggest otherwise but there’s a lack of evidence. UNDERGRADUATE• But people with Autism often make good progress and develop coping strategies.• Range of therapies and treatments but no real consensus on what is most effective.• Because there is a wide variability in people with Autism there is a need to develop an individual treatment and management plan. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 33 Section: 3 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 33