Your SlideShare is downloading. ×
Autism Spectrum Disorders (ASD) Cara Kimberg, M.S.
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Autism Spectrum Disorders (ASD) Cara Kimberg, M.S.

579

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
579
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Autism SpectrumAutism Spectrum Disorders (ASD)Disorders (ASD) Cara Kimberg, M.S.Cara Kimberg, M.S.
  • 2. What is Autism?What is Autism?  Four ways to “define” autismFour ways to “define” autism  DSM-IVDSM-IV  Parents with a child with autismParents with a child with autism  Individuals with autismIndividuals with autism  What we know (i.e. stereotypes of autism)What we know (i.e. stereotypes of autism)  Let’s take a look at each one to get a moreLet’s take a look at each one to get a more comprehensive idea of this disordercomprehensive idea of this disorder
  • 3. DSM-IV criteriaDSM-IV criteria  First, important to note that autism is aFirst, important to note that autism is a spectrumspectrum disorder characterized by:disorder characterized by:  Impairments inImpairments in social interactionsocial interaction  Impairments inImpairments in communicationcommunication  Presence ofPresence of restricted, repetitive behaviorsrestricted, repetitive behaviors (RRBs)(RRBs)  Spectrum = variability within and across these areasSpectrum = variability within and across these areas  1 in 150 children diagnosed with autism includes1 in 150 children diagnosed with autism includes the entire spectrumthe entire spectrum
  • 4. DSM-IV criteria (continued)DSM-IV criteria (continued)  Umbrella term is really Pervasive DevelopmentalUmbrella term is really Pervasive Developmental Disorders (PDD)Disorders (PDD)  5 different subtypes of PDD5 different subtypes of PDD  Autistic DisorderAutistic Disorder  Asperger’s DisorderAsperger’s Disorder  PDD-NOSPDD-NOS  Rhett’s DisorderRhett’s Disorder  Childhood Disintegrative DisorderChildhood Disintegrative Disorder Autism Spectrum Disorders
  • 5. Rhett’s Disorder (299.80)Rhett’s Disorder (299.80)  (A) All of the following:(A) All of the following:  apparently normal prenatal and perinatal developmentapparently normal prenatal and perinatal development  apparently normal psychomotor development through the first 5apparently normal psychomotor development through the first 5 months after birthmonths after birth  normal head circumference at birthnormal head circumference at birth  (B) Onset of all of the following after the period of normal development:(B) Onset of all of the following after the period of normal development:  deceleration of head growth between ages 5 and 48 monthsdeceleration of head growth between ages 5 and 48 months  loss of previously acquired purposeful hand skills between ages 5 and 30loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped handmonths with the subsequent development of stereotyped hand movements (e.g., hand-wringing or hand washing)movements (e.g., hand-wringing or hand washing)  loss of social engagement early in the course (although often socialloss of social engagement early in the course (although often social interaction develops later)interaction develops later)  appearance of poorly coordinated gait or trunk movementsappearance of poorly coordinated gait or trunk movements  severely impaired expressive and receptive language development withseverely impaired expressive and receptive language development with severe psychomotor retardationsevere psychomotor retardation
  • 6. Facts about Rhett’s DisorderFacts about Rhett’s Disorder  Complex neurological disorderComplex neurological disorder  Genetic in originGenetic in origin  Primarily in girlsPrimarily in girls  Present at birth but more apparent during second yearPresent at birth but more apparent during second year  Second most common cause of severe learningSecond most common cause of severe learning disability in girlsdisability in girls  1:10,000 to 1:23, 000 diagnosed1:10,000 to 1:23, 000 diagnosed  Period of temporary regression including loss ofPeriod of temporary regression including loss of communication skills, and purposeful hand movementscommunication skills, and purposeful hand movements
  • 7. Childhood Disintegrative Disorder (299.10)Childhood Disintegrative Disorder (299.10)  (A) Apparently normal development for at least the first 2 years after(A) Apparently normal development for at least the first 2 years after birth as manifested by the presence of age-appropriate verbal andbirth as manifested by the presence of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptivenonverbal communication, social relationships, play, and adaptive behavior.behavior.  (B) Clinically significant loss of previously acquired skills (before age 10(B) Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the following areas:years) in at least two of the following areas:  expressive or receptive languageexpressive or receptive language  social skills or adaptive behaviorsocial skills or adaptive behavior  bowel or bladder controlbowel or bladder control  playplay  motor skillsmotor skills  (C) Abnormalities of functioning in at least two of the following areas:(C) Abnormalities of functioning in at least two of the following areas:  qualitative impairment in social interaction (e.g., impairment inqualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to develop peer relationships, lack of socialnonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity)or emotional reciprocity)  qualitative impairments in communication (e.g., delay or lack of spokenqualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate or sustain a conversation, stereotyped andlanguage, inability to initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied make-believe play)repetitive use of language, lack of varied make-believe play)  restricted, repetitive, and stereotyped patterns of behavior, interests, andrestricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypies and mannerismsactivities, including motor stereotypies and mannerisms  (D) The disturbance is not better accounted for by another specific(D) The disturbance is not better accounted for by another specific Pervasive Developmental Disorder or by Schizophrenia.Pervasive Developmental Disorder or by Schizophrenia.
  • 8. Facts about ChildhoodFacts about Childhood Disintegrative DisorderDisintegrative Disorder  Child regresses from age 2-10 (debated) in termsChild regresses from age 2-10 (debated) in terms of language skills, social behavior, and allof language skills, social behavior, and all developmental motor skillsdevelopmental motor skills  Can occur abruptly or over a longer period ofCan occur abruptly or over a longer period of timetime  Sometimes child is aware of their loss of skillsSometimes child is aware of their loss of skills  No cureNo cure
  • 9. Autistic Disorder (299.0)Autistic Disorder (299.0)  (A) total of six (or more) items from (1), (2), and (3), with at(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):least two from (1), and one each from (2) and (3): 1)qualitative impairment in social interaction, as manifested by1)qualitative impairment in social interaction, as manifested by at least two of the following:at least two of the following:  (a)(a) marked impairment in the use of multiple nonverbalmarked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, bodybehaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interactionpostures, and gestures to regulate social interaction  (b)(b) failure to develop peer relationships appropriate tofailure to develop peer relationships appropriate to developmental leveldevelopmental level  (c)(c) a lack of spontaneous seeking to share enjoyment,a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack ofinterests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)showing, bringing, or pointing out objects of interest)  (d)(d) lack of social or emotional reciprocitylack of social or emotional reciprocity
  • 10. Autistic DisorderAutistic Disorder (2) qualitative impairments in communication as manifested by at(2) qualitative impairments in communication as manifested by at least one of the following:least one of the following:  (a) delay in, or total lack of, the development of spoken language(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through(not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime)alternative modes of communication such as gestures or mime)  (b) in individuals with adequate speech, marked impairment in(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with othersthe ability to initiate or sustain a conversation with others  (c) stereotyped and repetitive use of language or idiosyncratic(c) stereotyped and repetitive use of language or idiosyncratic languagelanguage  (d) lack of varied, spontaneous make-believe play or social(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental levelimitative play appropriate to developmental level
  • 11. Autistic DisorderAutistic Disorder (3)restricted repetitive and stereotyped patterns of behavior,(3)restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of theinterests, and activities, as manifested by at least one of the following:following:  (a) encompassing preoccupation with one or more stereotyped(a) encompassing preoccupation with one or more stereotyped patterns of interest that is abnormal either in intensity or focuspatterns of interest that is abnormal either in intensity or focus  (b) apparently inflexible adherence to specific, nonfunctional(b) apparently inflexible adherence to specific, nonfunctional routines or ritualsroutines or rituals  (c) stereotyped and repetitive motor mannerisms (e.g., hand or(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)finger flapping or twisting, or complex whole-body movements)  (d) persistent preoccupation with parts of objects(d) persistent preoccupation with parts of objects
  • 12. Autistic DisorderAutistic Disorder  (B) Delays or abnormal functioning in at least(B) Delays or abnormal functioning in at least one of the following areas, with onset prior toone of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language asage 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic orused in social communication, or (3) symbolic or imaginative play.imaginative play.  (C) The disturbance is not better accounted for(C) The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrativeby Rett's Disorder or Childhood Disintegrative Disorder.Disorder.
  • 13. Asperger’s Disorder (299.80)Asperger’s Disorder (299.80)  (A) Qualitative impairment in social interaction, as manifested(A) Qualitative impairment in social interaction, as manifested by at least two of the following:by at least two of the following:  marked impairment in the use of multiple nonverbal behaviors such asmarked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures toeye-to-eye gaze, facial expression, body postures, and gestures to regulate social interactionregulate social interaction  failure to develop peer relationships appropriate to developmental levelfailure to develop peer relationships appropriate to developmental level  a lack of spontaneous seeking to share enjoyment, interests, ora lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, orachievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)pointing out objects of interest to other people)  lack of social or emotional reciprocity.lack of social or emotional reciprocity.  (B) Restricted repetitive and stereotyped patterns of behavior,(B) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of theinterests, and activities, as manifested by at least one of the following:following:  encompassing preoccupation with one or more stereotyped andencompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focusrestricted patterns of interest that is abnormal either in intensity or focus  apparently inflexible adherence to specific, non-functional routines orapparently inflexible adherence to specific, non-functional routines or ritualsrituals  stereotyped and repetitive motor mannerisms (e.g., hand or fingerstereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)flapping or twisting, or complex whole-body movements)  persistent preoccupation with parts of objectspersistent preoccupation with parts of objects
  • 14. Asperger’s DisorderAsperger’s Disorder  (C) The disturbance causes clinically significant impairment in(C) The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.social, occupational, or other important areas of functioning.  (D) There is no clinically significant general delay in language(D) There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative(e.g., single words used by age 2 years, communicative phrases used by age 3 years)phrases used by age 3 years)  (E) There is no clinically significant delay in cognitive(E) There is no clinically significant delay in cognitive development or in the development of age-appropriate self-development or in the development of age-appropriate self- help skills, adaptive behavior (other than in socialhelp skills, adaptive behavior (other than in social interaction), and curiosity about the environment ininteraction), and curiosity about the environment in childhood.childhood.  (F) Criteria are not met for another specific Pervasive(F) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.Developmental Disorder or Schizophrenia.
  • 15. Pervasive Developmental Disorder-NOSPervasive Developmental Disorder-NOS (299.80)(299.80)  This category should be used when there is a severe andThis category should be used when there is a severe and pervasive impairment in the development of reciprocalpervasive impairment in the development of reciprocal social interaction or verbal and nonverbalsocial interaction or verbal and nonverbal communication skills, or when stereotyped behavior,communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria areinterests, and activities are present, but the criteria are not met for a specific Pervasive Developmentalnot met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal PersonalityDisorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. ForDisorder, or Avoidant Personality Disorder. For example, this category includesexample, this category includes atypical autismatypical autism ------ presentations that do not meet the criteria for Autisticpresentations that do not meet the criteria for Autistic Disorder because of late age of onset, atypicalDisorder because of late age of onset, atypical symptomatology, or subthreshold symptomatology, orsymptomatology, or subthreshold symptomatology, or all of these.all of these.
  • 16. Parents of children with ASDParents of children with ASD  http://www.autismspeaks.org/sponsoredevents/authttp://www.autismspeaks.org/sponsoredevents/auti  Impact on the familyImpact on the family  SocialSocial  FinancialFinancial  Everyday routinesEveryday routines  Variable experiences based on an individualVariable experiences based on an individual child and his/her strengths and weaknesseschild and his/her strengths and weaknesses
  • 17. Anecdotal StoriesAnecdotal Stories (www.Autismspeaks. org)(www.Autismspeaks. org)
  • 18. Individuals with AutismIndividuals with Autism  http://www.autismspeaks.org/video/index.phphttp://www.autismspeaks.org/video/index.php  How people with autism see the worldHow people with autism see the world  Life of Adults with AutismLife of Adults with Autism  Temple Grandin “Autism the way I see it”Temple Grandin “Autism the way I see it”  Different types of thinking in autismDifferent types of thinking in autism  1.Visual thinking - Thinking in Pictures, like mine1.Visual thinking - Thinking in Pictures, like mine 2. Music and Math thinking2. Music and Math thinking 3. Verbal logic thinking3. Verbal logic thinking  Play to strengths to be most effectivePlay to strengths to be most effective  http://autisticsavant.blogspot.com/2007_05_27_archive.htmhttp://autisticsavant.blogspot.com/2007_05_27_archive.htm
  • 19. Story from a Teenager with ASDStory from a Teenager with ASD  ““The characteristics of people with Asperger's are the perfect ones to makeThe characteristics of people with Asperger's are the perfect ones to make obtaining friends difficult. Asperger's Syndrome is part of a spectrum of autisticobtaining friends difficult. Asperger's Syndrome is part of a spectrum of autistic disorders, all linked by a level of non-communication. At the lowest level, wedisorders, all linked by a level of non-communication. At the lowest level, we have cases like my brother Eric, a person trapped in a void wherehave cases like my brother Eric, a person trapped in a void where communication is only at the most rudimentary level, about the level of a non-communication is only at the most rudimentary level, about the level of a non- expressive two or three year old. Then among several forms at the highest level,expressive two or three year old. Then among several forms at the highest level, we have Asperger's syndrome. Those with Asperger's often suffer from awe have Asperger's syndrome. Those with Asperger's often suffer from a plethora of symptoms. The most prominent ones are difficulty with readingplethora of symptoms. The most prominent ones are difficulty with reading people's body language, a singular interest in a subject or several subjects (frompeople's body language, a singular interest in a subject or several subjects (from my own life, I have one major interest in rock music, compulsively looking formy own life, I have one major interest in rock music, compulsively looking for new reviews and obsessing over the best quality of sound to listen to them), anew reviews and obsessing over the best quality of sound to listen to them), a slight monotone voice, struggling with proper body distance, and a tendency toslight monotone voice, struggling with proper body distance, and a tendency to use a vocabulary that is of a slightly higher sophistication than most peopleuse a vocabulary that is of a slightly higher sophistication than most people would use such as when I employ words like vitriolic, inundate, smorgasbord,would use such as when I employ words like vitriolic, inundate, smorgasbord, plethora, paraphernalia, and others of that variety. While obviously everyplethora, paraphernalia, and others of that variety. While obviously every person with the syndrome may not experience each and every single trait, Iperson with the syndrome may not experience each and every single trait, I have experienced all of these symptoms to some degree. Couple that with ahave experienced all of these symptoms to some degree. Couple that with a fairly shy personality, a shyness that may or may not have anything to do withfairly shy personality, a shyness that may or may not have anything to do with Asperger's Syndrome, and I am often left feeling like everyone sees me as beingAsperger's Syndrome, and I am often left feeling like everyone sees me as being quiet and not worth talking to.”quiet and not worth talking to.”  (Autismspeaks.org)(Autismspeaks.org)
  • 20. Stereotypes about ASDStereotypes about ASD  Head bangingHead banging  Hand flappingHand flapping  Non-communicativeNon-communicative  Non-verbalNon-verbal  ““own world”own world”
  • 21. How is Autism Diagnosed?How is Autism Diagnosed?  Autism Diagnostic Observation Schedule (ADOS; LordAutism Diagnostic Observation Schedule (ADOS; Lord et al)et al)  Autism Diagnostic Interview-Revised (ADI-R; Rutter etAutism Diagnostic Interview-Revised (ADI-R; Rutter et al)al)  Social Communication Questionnaire (SCQ; Rutter etSocial Communication Questionnaire (SCQ; Rutter et al)al)  Childhood Autism Rating Scale (CARS; Schopler et al)Childhood Autism Rating Scale (CARS; Schopler et al)  Clinical judgment plays a HUGE roleClinical judgment plays a HUGE role  What are the dangers of this?What are the dangers of this?  Potential differential diagnoses (type ofPotential differential diagnoses (type of language/communication disorder, OCD, anxiety disorder)language/communication disorder, OCD, anxiety disorder)
  • 22. Benefits of Early DiagnosisBenefits of Early Diagnosis  Treatment and intervention effectivenessTreatment and intervention effectiveness  Skill acquisitionSkill acquisition  exposureexposure
  • 23. Types of Treatments/InterventionsTypes of Treatments/Interventions  Interpersonal Relationship Intervnetions andInterpersonal Relationship Intervnetions and TreatmentsTreatments  Skill-Based Interventions and TreatmentSkill-Based Interventions and Treatment  Cognitive Interventions and TreatmentCognitive Interventions and Treatment  Physiological/Biological/NeurologicalPhysiological/Biological/Neurological Interventions and TreatmentInterventions and Treatment  Other Interventions, Treatments and RelatedOther Interventions, Treatments and Related AgentsAgents
  • 24. Interpersonal RelationshipInterpersonal Relationship  Social-affective interpretation of ASDSocial-affective interpretation of ASD  Need for people with ASD to expressNeed for people with ASD to express attachments to others appropriatelyattachments to others appropriately  Seek to facilitate affect, attachment, bonding,Seek to facilitate affect, attachment, bonding, sense of relatednesssense of relatedness  Holding Therapy (not recommended)Holding Therapy (not recommended)  Developmental, Individual-Difference RelationshipDevelopmental, Individual-Difference Relationship Based Model (Floortime; www.icdl.com)Based Model (Floortime; www.icdl.com)
  • 25. Skill-BasedSkill-Based  Most common methods used by schoolsMost common methods used by schools  Intent is to develop and support functionalIntent is to develop and support functional demonstration of specific skills rather than to facilitatedemonstration of specific skills rather than to facilitate bondingbonding  Target specific skills to teach to improve functioning inTarget specific skills to teach to improve functioning in specific areasspecific areas  Picture Exchange Communication System (PECS)Picture Exchange Communication System (PECS)  Facilitated Communication (not recommended)Facilitated Communication (not recommended)  Assistive TechnologyAssistive Technology  Applied Behavior Analysis (Scientifically Based Practice)Applied Behavior Analysis (Scientifically Based Practice)  TEACCHTEACCH
  • 26. CognitiveCognitive  Teaching individuals with ASD to monitor theirTeaching individuals with ASD to monitor their own behavior and performanceown behavior and performance  Shift control from others to the individualsShift control from others to the individuals  Connection between thoughts, feelings andConnection between thoughts, feelings and behaviorbehavior  Social StoriesSocial Stories  Social Decision Making StrategiesSocial Decision Making Strategies  LEAP (Scientifically Based Practice)LEAP (Scientifically Based Practice)
  • 27. Physiological/Biological/NeurologicalPhysiological/Biological/Neurological  Address the neurological dysfunctions or problemsAddress the neurological dysfunctions or problems thought to exist at the core of ASDthought to exist at the core of ASD  Alter way in which neurological system processesAlter way in which neurological system processes information, the manner in which information isinformation, the manner in which information is received, chemistry and processes associated withreceived, chemistry and processes associated with sensations, perceptions and emotionssensations, perceptions and emotions  Irlen Lenses (limited support)Irlen Lenses (limited support)  Sensory integration (promising practice)Sensory integration (promising practice)  Auditory Integration Training (limited support)Auditory Integration Training (limited support)  Pharmacology (promising practice)Pharmacology (promising practice)
  • 28. OthersOthers  Mercury: Vaccinations and Autism (limitedMercury: Vaccinations and Autism (limited support)support)  Gluten-Casein Intolerance (limited support)Gluten-Casein Intolerance (limited support)  Music therapy (limited support)Music therapy (limited support)
  • 29. Controversies with TreatmentsControversies with Treatments  Limited scientific supportLimited scientific support  Treatments as a “cure”Treatments as a “cure”  Decisions regarding financial resourcesDecisions regarding financial resources  Where does research money go?Where does research money go?  Autism is all over the newsAutism is all over the news
  • 30. Community ResourcesCommunity Resources  Center for Autism and Related DisabilitiesCenter for Autism and Related Disabilities

×