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Autism Spectrum Disorders Workshop for SPALS


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Autism Spectrum Disorders Workshop for SPALS

  1. 1. 1 Autism Spectrum Disorders Workshop for SPALS Baton Rouge, LA September 2003 Glenis Benson, Ph.D.
  2. 2. Today’s Agenda • Fundamentals • Early Identification • Characteristics • Interventions
  3. 3. Pervasive Developmental Disorders (PDD) = Autism Spectrum Disorder (ASD) • pattern of deficits in communication, socialization and behaviors and interests
  4. 4. Pervasive Developmental Disorders (Diagnostic and Statistical Manual DSM-IV, APA 1994) • Autistic Disorder • Asperger’s Disorder • Rett’s Disorder • Childhood Disintegrative Disorder • Pervasive Developmental Disorder-Not Otherwise Specified
  5. 5. Pervasive Developmental Disorders (Diagnostic and Statistical Manual, DSM-IV, APA 1994) • Autistic Disorder • Asperger’s Disorder • Rett’s Disorder • Childhood Disintegrative Disorder • Pervasive Developmental Disorder-Not Otherwise Specified
  6. 6. Diagnostic Criteria for Autistic Disorder (DSM-IV, APA 1994) • qualitative impairment in social interaction • qualitative impairments in communication • restricted repetitive and stereotyped patterns of behavior, interests and activities • onset prior to 3 years of age
  7. 7. -Qualitative impairment in social interaction • marked impairment in the use of multiple nonverbal behaviors such as eye to eye gaze, facial expression, body postures and gestures to regulate social interaction • failure to develop peer relationships appropriate to developmental level • a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) • lack of social or emotional reciprocity
  8. 8. -Qualitative impairment in communication • delay in, or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) • in individuals with adequate speech, marked impairment in the ability to initiate or sustain conversation with others • stereotyped and repetitive use of language or idiosyncratic language • lack of varied, spontaneous make-believe play or social imitative play appropriate to
  9. 9. -Restricted repetitive and stereotyped patterns, 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 is abnormal either in intensity or focus • apparently inflexible 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
  10. 10. Autistic Disorder • impairments in: – socialization, – communication, and – behaviors / interests • at least two signs from social, and one sign from each communicative, and behavior/interests • must meet 6 or more criteria
  11. 11. Asperger’s Disorder: • impairments in: - socialization, described as “active, but odd” - one or more areas of narrow, circumscribed interest • no, or only mild delays in language - single words by 2 years of age, phrases by 3 • no significant delay in cognitive development or adaptive behaviors
  12. 12. PDD-NOS (Pervasive Developmental Disorder-Not Otherwise Specified) • implies the presence of fewer, and at times less severe signs of autism • can be thought of as a milder form of autism • “those meeting fewer criteria are diagnosable as PDD-NOS” • the lower limit is not clearly specified • sometimes called ‘atypical autism’
  13. 13. Autism Spectrum Disorders constitute a SYNDROME • affected individuals will not have ALL the associated signs and symptoms • therefore no two persons with autism are alike! (no different from no two neurotypicals being alike) • many different causes, resulting in an overlapping set of symptoms
  14. 14. Cognitive ability (Fonbonne, 1999) • 75-80% are dually diagnosed with mental retardation • only 20-25% have IQs>70 • girls are more likely to have mental retardation
  15. 15. Communicative ability • 50% remain nonverbal • 85% of talkers once were echolalic • fairly good language skills before 5 or 6 years of age are indicative of intellectual/social competence later in life
  16. 16. Social ability • desirous, but inept/awkward • appear aloof
  17. 17. Seizure disorder: • 25%-33% will develop seizure disorder (Bristol, 1996, Kanner, 2000, Tuchman, 2000)
  18. 18. How common are Autism Spectrum Disorders combined? • 3/500 (current epidemiological-Baird et al, 2000, Chakrabarti & Fonbonne, 2001) • 3-4/1000 (or 1.5-2/500) Yeargin- Allsopp, 2003)
  19. 19. In relation to other disabilities... • At this rate ASDS are: – 5X more common than Down Syndrome – 3X more common than juvenile diabetes
  20. 20. In Louisiana there should be 26,895 people with a disorder on the Autism Spectrum
  21. 21. Epidemic anyone???? • Under diagnosed in the 70’s • Criteria have been consistent for some time • Addition of Asperger’s in 1994 • Prevalence of PDD-NOS diagnosis • Far better diagnostics • Diagnostic tool meshes with diagnostic criteria • Professionals no longer ‘avoid’ the
  22. 22. Male to Female Ratio (Fonbonne, 1999) • see more boys than girls, – 3-4/1 for Autism – 10/1 for Aspergers • ratio indicative of a biological origin
  23. 23. Do we know what causes Autism? • usually it is impossible to demonstrate WHAT caused Autism in a particular child
  24. 24. Vaccinations (MMR jab) • “flavor of the month” • VERY controversial • numerous studies show NO RELATION (Fonbonne & Chakrabarti, 2001; Madsen et al, 2002; Taylor et al. 2002)
  25. 25. Well then what about thimerosal, or mercury- containing vaccines? • Evidence for a CAUSAL association for autism is weak (Stratton et al., 2001; Pichiechero et al, 2002)
  26. 26. Why do people think vaccines? • numbered heads for 6 groups • As a team, develop a question to ask another group • Write that question on a piece of paper
  27. 27. For a substantial subset, autism has genetic involvement.. It’s in the genes
  28. 28. Genetics of Autism • Bauman (2002) “It is a complicated disorder.” “It is likely that there is more than one gene involved, but there is no consensus on the gene or genes … studies continue on genetic vulnerability,” • Whether this is primarily a genetic disorder or a genetic vulnerability for other external factors remains to be determined.
  29. 29. • Autism is a behavioral manifestation of various brain abnormalities that likely develop as a result of a combination of genetic predispositions and early environmental (probably in utero) insults. • (Herbert, Sharp & Gaudiano, 2002)
  30. 30. No empirical support for: • Unloving mothers • yeast infections • childhood vaccinations
  31. 31. What we know: • Acceleration then deceleration in brain growth (many areas have increased volume) • Increased neuronal packing and decreased cell size in the limbic system • enlarged amygdala • fusiform facial gyrus is not activated by facial information
  32. 32. Functional and structural abnormalities • Amygdala (important for emotion and behavior) – recognition of affect/emotions/faces, perception of body movements, eye gaze direction, orienting to social stimuli, understanding stimulus-reward associations • Hippocampus (memory and learning) – hyperactivity, disordered responses to new situations, and stereotypic mannerisms
  33. 33. What role do medications have in the treatment of autism? • none have been found to treat autism as a whole • medications can treat symptoms only • no pharmacologic agents with FDA- approved labeling for autism
  34. 34. History of Diagnoses • autism was described by Kanner in 1943 • not in the DSM until DSM-III in 1980 – narrow definition that focused on younger, more impaired • DSM-III-R in 1987 – definition was more inclusive • Asperger’s added in DSM-IV in 1994 • 20 years later and we discuss an
  35. 35. Diagnosis will vary according to the knowledge base and analytical prowess of the diagnostician
  36. 36. No one thing can make or break a diagnosis! • E.g., sense of humour, physically affectionate