Autism UpdateAutism Update
M. Ellen Gellerstedt, MD,M. Ellen Gellerstedt, MD,
FAAPFAAP
Eastern Maine Medical CenterEastern...
AutismAutism
Complex neurobehavioral disorderComplex neurobehavioral disorder
characterized by:characterized by:
• Impairm...
Autism: DSM-IVAutism: DSM-IV
• Qualitative impairment in socialQualitative impairment in social
interaction as shown by at...
Autism Diagnosis DSM-IVAutism Diagnosis DSM-IV
 Qualitative Impairment inQualitative Impairment in
communication as manif...
Autism Diagnosis DSM-IVAutism Diagnosis DSM-IV
 Restricted repetitive andRestricted repetitive and
stereotyped patterns o...
Pervasive DevelopmentalPervasive Developmental
DisordersDisorders
 Autistic Disorder (299.00)Autistic Disorder (299.00)
...
Autism Spectrum Disorders –Autism Spectrum Disorders –
confusing terminologyconfusing terminology
 PDD vs. PDD, NOSPDD vs...
Explanatory ModelsExplanatory Models
 Theory of MindTheory of Mind
 Mind BlindnessMind Blindness
 OthersOthers
Etiology of AutismEtiology of Autism
 Probably no single etiologyProbably no single etiology
 Approximately 10% may beAp...
Etiology of AutismEtiology of Autism
 Likely interplay of geneticLikely interplay of genetic
predisposition and precipita...
What you are looking forWhat you are looking for
 Atypical use ofAtypical use of
non-verbalnon-verbal
behaviorsbehaviors
...
What you are looking forWhat you are looking for
 Impaired SpontaneousImpaired Spontaneous
seeking to shareseeking to sha...
What you are looking forWhat you are looking for
 RestrictedRestricted
interests,interests,
stereotypies, andstereotypies...
What you are looking forWhat you are looking for
 AtypicalAtypical
development ofdevelopment of
spoken languagespoken lan...
What you are looking forWhat you are looking for
 Atypical social andAtypical social and
emotionalemotional
reciprocityre...
SpecificallySpecifically
 Does the childDoes the child
respond to parentalrespond to parental
attentionattention
 Does t...
www.firstsigns.orgwww.firstsigns.org
On the SpectrumOn the Spectrum
Thank YouThank You
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  • DSM-IV Criteria for Autistic Disorder ASSUME WE NEED PERMISSION TO USE????
    At least 6 items from Categories 1, 2, and 3.
    AND at least two items from category 1. AND at least one item from category 2 and category 3
    Category 1 – Qualitative impairment in social interaction as shown by at least two (2) of the following:
    Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gase, facial expression, body postures, and gestures to regulate social interaction.
    Failure to develop peer relationships appropriate to developmental level
    Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people ( e.g., lack of showing, bringing, or pointing out objects of interest to other people)
    Lack of social or emotional reciprocity
    Category 2- Qualitative Impairment in communication as manifested by at least one of the following:
    Delay in, or total lack of , the development of spoken language (not accompanied by an attempt to compensate thorugh alternative means of communication, such as gestures or mime)
    In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
    Stereotyped and repetitive use of language or idiosyncratic language
    Lack of varied spontaneous make-believe paly or social imitative play appropriate to developmental level.
    Category 3 – Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
    Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal either in intensity or focus
    Apparently compulsive adherence to specific, nonfunctional routines or rituals
    Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements)
    Persistent preoccupation with parts of objects
  • PPT

    1. 1. Autism UpdateAutism Update M. Ellen Gellerstedt, MD,M. Ellen Gellerstedt, MD, FAAPFAAP Eastern Maine Medical CenterEastern Maine Medical Center May 12, 2009May 12, 2009
    2. 2. AutismAutism Complex neurobehavioral disorderComplex neurobehavioral disorder characterized by:characterized by: • Impairment in social interactionImpairment in social interaction • Impairment in communicationImpairment in communication • Restricted, perseverativeRestricted, perseverative behaviors, interests, and activitiesbehaviors, interests, and activities
    3. 3. Autism: DSM-IVAutism: DSM-IV • Qualitative impairment in socialQualitative impairment in social interaction as shown by atinteraction as shown by at least two (2) of the following:least two (2) of the following:  Marked impairment in nonverbalMarked impairment in nonverbal behaviorsbehaviors  Failure to form developmentallyFailure to form developmentally appropriate relationshipsappropriate relationships  Lack of spontaneous seeking to shareLack of spontaneous seeking to share enjoyment, interests, orenjoyment, interests, or achievements with other peopleachievements with other people  Lack of social or emotional reciprocityLack of social or emotional reciprocity
    4. 4. Autism Diagnosis DSM-IVAutism Diagnosis DSM-IV  Qualitative Impairment inQualitative Impairment in communication as manifested bycommunication as manifested by at least one of the following:at least one of the following: • Spoken language or gestureSpoken language or gesture • Ability to initiate or sustain aAbility to initiate or sustain a conversationconversation • Stereotyped and repetitive use ofStereotyped and repetitive use of language or idiosyncratic languagelanguage or idiosyncratic language • Lack of varied make-believe play orLack of varied make-believe play or social imitative play appropriate tosocial imitative play appropriate to developmental level.developmental level.
    5. 5. Autism Diagnosis DSM-IVAutism Diagnosis DSM-IV  Restricted repetitive andRestricted repetitive and stereotyped patterns of behavior,stereotyped patterns of behavior, interests, and activities, asinterests, and activities, as manifested by at least one of themanifested by at least one of the following:following: • Stereotyped and restricted patterns ofStereotyped and restricted patterns of interestinterest • Adherence to specific, nonfunctionalAdherence to specific, nonfunctional routines or ritualsroutines or rituals • Stereotyped and repetitive motorStereotyped and repetitive motor mannerismsmannerisms • Preoccupation with parts of objectsPreoccupation with parts of objects
    6. 6. Pervasive DevelopmentalPervasive Developmental DisordersDisorders  Autistic Disorder (299.00)Autistic Disorder (299.00)  Asperger’s Disorder (299.80)Asperger’s Disorder (299.80)  Pervasive DevelopmentalPervasive Developmental Disorder, NOS (299.80)Disorder, NOS (299.80)  Rett Syndrome (299.80)Rett Syndrome (299.80)  Childhood DisintegrativeChildhood Disintegrative Disorder (299.10)Disorder (299.10)
    7. 7. Autism Spectrum Disorders –Autism Spectrum Disorders – confusing terminologyconfusing terminology  PDD vs. PDD, NOSPDD vs. PDD, NOS  Asperger vs High FunctioningAsperger vs High Functioning AutismAutism  Autism with or withoutAutism with or without mental retardationmental retardation  Autism Spectrum DisorderAutism Spectrum Disorder
    8. 8. Explanatory ModelsExplanatory Models  Theory of MindTheory of Mind  Mind BlindnessMind Blindness  OthersOthers
    9. 9. Etiology of AutismEtiology of Autism  Probably no single etiologyProbably no single etiology  Approximately 10% may beApproximately 10% may be behavioral profile associated withbehavioral profile associated with specific condition – e.g.specific condition – e.g. Tuberous Sclerosis, Fragile XTuberous Sclerosis, Fragile X syndrome, untreatedsyndrome, untreated phenylketonuria, othersphenylketonuria, others  Probably more than one geneProbably more than one gene responsible for vulnerabilityresponsible for vulnerability
    10. 10. Etiology of AutismEtiology of Autism  Likely interplay of geneticLikely interplay of genetic predisposition and precipitatingpredisposition and precipitating event(s)event(s) EnvironmentalEnvironmental InfectiousInfectious ImmunologicImmunologic OtherOther  Large multisite studies underwayLarge multisite studies underway to further investigate causesto further investigate causes
    11. 11. What you are looking forWhat you are looking for  Atypical use ofAtypical use of non-verbalnon-verbal behaviorsbehaviors • Eye gazeEye gaze • GesturesGestures • Facial expressionFacial expression
    12. 12. What you are looking forWhat you are looking for  Impaired SpontaneousImpaired Spontaneous seeking to shareseeking to share enjoymentenjoyment Joint AttentionJoint Attention
    13. 13. What you are looking forWhat you are looking for  RestrictedRestricted interests,interests, stereotypies, andstereotypies, and repetitiverepetitive behaviorsbehaviors
    14. 14. What you are looking forWhat you are looking for  AtypicalAtypical development ofdevelopment of spoken languagespoken language Language regressionLanguage regression EcholaliaEcholalia Not turning to nameNot turning to name
    15. 15. What you are looking forWhat you are looking for  Atypical social andAtypical social and emotionalemotional reciprocityreciprocity • Responding toResponding to namename • Orient towardOrient toward peoplepeople
    16. 16. SpecificallySpecifically  Does the childDoes the child respond to parentalrespond to parental attentionattention  Does the childDoes the child watch the parentwatch the parent for social cuesfor social cues  Does the childDoes the child respond to his/herrespond to his/her namename
    17. 17. www.firstsigns.orgwww.firstsigns.org On the SpectrumOn the Spectrum
    18. 18. Thank YouThank You

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