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AUTISM SPECTRUM DISORDER
Georgina Peacock, MD, MPH, FAAP
GCAN
December 5, 2013
Autism
• Autism first described by psychiatrist Leo Kanner
in 1943 in the US
• Hans Asperger described “autistic
psychopat...
• About 4 million babies born in
the US each year
• 1 in 6 children will have a
developmental disability
• 1 in 88 with au...
Public Health Concern
 Children with autism or developmental delays are at
increased risk for poor outcomes

 Early inte...
19 month old twins
Autism
•

Developmental disability
•
•

•

Complex disorder
•

•

Not recognizable at birth
Typically lifelong

Many areas...
ASD Characteristics Vary
Social Interaction
Aloof-----------------Passive-------------Active but odd

Communication
Nonver...
Pervasive Developmental Disorders (PDDs) to
Autism Spectrum Disorder (ASD)

DSM-IV,TR
1994, 2000

DSM-5

May 2013

Pervasi...
Changes from DSM-IV to DSM-5
DSM-IV

DSM-5
Autism Spectrum Disorder 299.0 (ICD10 F84)
A. Persistent deficits in social communication and
interactions
1. Social-emoti...
Autism Spectrum Disorder 299.0 continued
B. Restricted, repetitive patterns of behavior, interests, and
activities (at lea...
Autism Spectrum Disorder 299.0 continued
C. Symptoms must be present in the early
developmental period (but may not become...
Diagnostic challenges
ASD may be diagnosed with other overlapping disorders such as ADHD,
Language Impairments

Language
D...
• What happens to my child’s
diagnosis? Was the dx wrong?
• Do we need to go through the
diagnostic process again?
• Will ...
Autism Spectrum Disorder

ROLE FOR EARLY IDENTIFICATION
(CDC, 2012)

• Most children identified with ASD had a
developmental concern documented in their
evaluation records before...
Learn the Signs. Act Early.
Goal: To improve early
identification of autism and
other developmental disabilities
so childr...
Learn the Signs. Act Early.
 Learn the Signs:
 Resources for monitoring key
developmental milestones among ALL
children
...
•

Well-child visits for ALL children should include:
Developmental Screening
•

Use of a validated screening tool at
9, 1...
% Reported Developmental Monitoring and/or
Screening

Monitoring ONLY
36.9
42.0

Monitoring AND
Screening
Screening ONLY
N...
Acknowledgements
• Catherine Rice
• Learn the Signs. Act Early Team
Thank you!
Georgina Peacock
gpeacock@cdc.gov
New Diagnosis =
Social (Pragmatic) Communication
Disorder
• A Communication Disorder
• Impairments in use of social
commun...
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Autism Spectrum Disorder

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This powerpoint presentation was put together by Georgina Peacock, MD, MPH, Developmental-Behavioral Pediatrician for the Centers for Disease Control and Prevention's National Center on Birth Defects, and presented on December 5 at our Georgia Children's Advocacy Network (GA-CAN!) Off-Session Policy Series. This month our panelists discussed the complex topic of autism, it's diagnosis, treatment and coverage.

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Autism Spectrum Disorder

  1. 1. AUTISM SPECTRUM DISORDER Georgina Peacock, MD, MPH, FAAP GCAN December 5, 2013
  2. 2. Autism • Autism first described by psychiatrist Leo Kanner in 1943 in the US • Hans Asperger described “autistic psychopathology” in 1944 in Austria (work later translated in the 1980‟s to recognize „Asperger syndrome‟) • Autism was once seen as a rare condition Learn the Signs. Act Early. www.cdc.gov/actearly
  3. 3. • About 4 million babies born in the US each year • 1 in 6 children will have a developmental disability • 1 in 88 with autism* (Boyle et al., 2011; CDC, 2012) * Autism Spectrum Disorders (ASDs)
  4. 4. Public Health Concern  Children with autism or developmental delays are at increased risk for poor outcomes  Early intervention can significantly impact acquisition of important lifeskills  Many children with developmental disabilities are not identified until kindergarten or later – – Only 30% of children with DD identified before Kindergarten (Palfrey, 1987) Only 18% of children with ASD identified by age 3 years (CDC, ADDM 2012)  Children from low income and/or minority families experience longer delays in receiving services
  5. 5. 19 month old twins
  6. 6. Autism • Developmental disability • • • Complex disorder • • Not recognizable at birth Typically lifelong Many areas affected Wide range of impairment • Mild to severe across areas Learn the Signs. Act Early. www.cdc.gov/actearly
  7. 7. ASD Characteristics Vary Social Interaction Aloof-----------------Passive-------------Active but odd Communication Nonverbal----------------------------------------------Verbal Behaviors Intense-----------------------------------------------------Mild Measured Intelligence Severe---------------------------------------------------Gifted Adaptive Functioning Low-------------------------Variable----------High in areas
  8. 8. Pervasive Developmental Disorders (PDDs) to Autism Spectrum Disorder (ASD) DSM-IV,TR 1994, 2000 DSM-5 May 2013 Pervasive Developmental Disorders: Autistic disorder Asperger’s PDD-NOS Autism Spectrum Disorder Retts CDD Diagnostic and Statistical Manual (DSM), American Psychiatric Association
  9. 9. Changes from DSM-IV to DSM-5 DSM-IV DSM-5
  10. 10. Autism Spectrum Disorder 299.0 (ICD10 F84) A. Persistent deficits in social communication and interactions 1. Social-emotional reciprocity 2. Nonverbal communication behaviors used for social interactions; 3. Developing, maintaining, and understanding relationships
  11. 11. Autism Spectrum Disorder 299.0 continued B. Restricted, repetitive patterns of behavior, interests, and activities (at least TWO of the following): 1. Stereotyped or repetitive motor movements, use of objects, or speech 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior 3. Highly restricted, fixated interests 4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment
  12. 12. Autism Spectrum Disorder 299.0 continued C. Symptoms must be present in the early developmental period (but may not become fully recognized until social demands exceed limited capacities) D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
  13. 13. Diagnostic challenges ASD may be diagnosed with other overlapping disorders such as ADHD, Language Impairments Language Disorders Learning Disabilities ADHD Intellectual Disability ASD Anxiety Etc… ADOS-2 trainer’s slides
  14. 14. • What happens to my child’s diagnosis? Was the dx wrong? • Do we need to go through the diagnostic process again? • Will services change? • What happens to me? • I am an Aspie! • Do I have to go through more evaluation? • Will services change? People with Autism Families • How does this change my practice? • How to I learn the new concepts? • New training, tools ($)? • How will I define my samples? Comparability? • Is this valid and reliable? • Impact on research funding? • What does this mean for current policies and laws? • What are the costs? • Personnel needs? Clinical and Educational Professionals Researchers Policy Makers
  15. 15. Autism Spectrum Disorder ROLE FOR EARLY IDENTIFICATION
  16. 16. (CDC, 2012) • Most children identified with ASD had a developmental concern documented in their evaluation records before the age of 2 years, but • Diagnosis often not until after age 4 years • 82% of children with ASD did not have a diagnosis by age 3 years • 21% of children with ASD did not have a diagnosis by age 8 years Significant lag exists between concern and diagnosis
  17. 17. Learn the Signs. Act Early. Goal: To improve early identification of autism and other developmental disabilities so children and their families can get the services and support they need
  18. 18. Learn the Signs. Act Early.  Learn the Signs:  Resources for monitoring key developmental milestones among ALL children  “Red flags” that can indicate concern  Act Early:     Discuss Concerns Proactive Screening Refer for evaluation and services Find resources for early intervention and family support
  19. 19. • Well-child visits for ALL children should include: Developmental Screening • Use of a validated screening tool at 9, 18, 24 or 30 months • ASD-specific screening 18 and 24 or 30 months • If concern identified: 1. Refer for intervention 2. Refer for evaluation AAP Policy Statement (2006)
  20. 20. % Reported Developmental Monitoring and/or Screening Monitoring ONLY 36.9 42.0 Monitoring AND Screening Screening ONLY Neither 5.7 15.4 National Survey of Children’s Health (NSCH) 2007; ages 10-47 months Preliminary results, not for
  21. 21. Acknowledgements • Catherine Rice • Learn the Signs. Act Early Team
  22. 22. Thank you! Georgina Peacock gpeacock@cdc.gov
  23. 23. New Diagnosis = Social (Pragmatic) Communication Disorder • A Communication Disorder • Impairments in use of social communication • No Restricted and Repetitive Behaviors like ASD – How is SCD similar and different from Pragmatic Language Disorder, Nonverbal Learning Disability, and PDD-NOS?

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