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  1. 1. AUTISM • A pervasive developmental disorder whose symptoms are first observed in infancy or early childhood (by age 3). See handout for Parental Concerns that Are Red Flags for Autism • Apparent social deficits and bizarre responses: failure to cuddle, lack of eye contact, aversion to physical affection; indifferent to social contact, proneness to temper tantrums; autistic aloneness in areas of language, behavior, cognitive development and social relationships; echopraxia; physical and emotional distance; inability to respond to others’ feelings; mindblindness (the inability to interpret the intentions, beliefs or behaviors of others); may walk on tiptoe; great deal of time spinning objects, flicking their fingers or rocking their bodies. Note: surprisingly about 40% of autistic children are securely attached to their mothers, who demonstrated a particular sensitivity to them. • Abnormal language development, including echolalia, pronominal reversal; perserveration; high-pitched, bird-like squeaking voice; verbal skills may be stilted, too perfect, with no subtleties of emotional tone; failure to imitate gestures or imaginative play; nonverbal skills remain poor. Approximately half of all autistic children do not develop speech at all. Executive functions of the cerebral cortex—planning, inhibition of response, flexibility and working memory—are often poor or missing • Negative responses to changes in routine; insistence on rigid adherence to the usual way of doing everything; Kanner, who first described autism in 1943 described their “obsessive desire for the maintenance of sameness”; change brings tantrums; intense attachment to objects; stereotypies; self-injurious behaviors such as head banging 25-40% score above 70 on IQ tests, and range from normal to gifted, but approximately 70% are mentally retarded; sometimes accompanied by savant capacities (areas of surprising talent in other wise low functioning individuals include music, drawing, and calendar calculations), i.e. Dustin Hoffman’s character in Rain Man
  2. 2. • Rare condition: 4 cases in 10,000; boys > girls: 3:1. Autism in girls is more severe in retardation. Most recent research suggests that the number of autistic children is increasing, reason unknown. • Etiology: What does not cause autism is the personalities or the relational dynamic of the mother and father. Biological causes are supported by family and twin studies, abnormalities in the size of the brain, the structure of the cerebellum, the high rates of seizure activities in adolescent autistics, abnormal brain waves and faulty neurotransmission of dopamine and serotonin. Autistic children also experience other biological disorders, such as Fragile X syndrome, German measles, encephalitis and phenylketonuria. These children had also experienced a higher rate of obstetric and neonatal complications, such as maternal rubella infection. • Diagnosis is often difficult because the children appear physically normal and their motor skills develop properly initially. Staring, rocking and head banging are not uncommon in healthy children at this age. Research has suggested that the absence of four behaviors could identify children later diagnosed with autism with 91% accuracy. The four behaviors are eye contact, showing an object to another person, pointing to objects and responding to their own names. A single behavior could predict diagnosis in 77% of the cases —the number of times a child looked at another person’s face. Treatment: intensive behavior therapy and educational intervention; Ivar Lovaas is well-known for his intensive treatment program called The Young Autism Project (illustrated by the video entitled Autism: The Child Who Couldn’t Play); Intensive means 40+ hours per week for three years, with the parents involvement an essential component of the program; Lovaas has data to support this time-intensive intervention; in one well-known study the IQ of the subjects was increased by 20 points and were able to move into a regular kindergarten class. The curriculum consisted of teaching imitation behavior and expression of feeling and reducing self-stimulating behaviors, and preliminary reading and writing skills. A later follow up of the children, at age 13, found that the mean IQ of the subjects was 85, compared to the mean IQ of 55 for the control group. For another promising program from North Carolina, see TEACCH on pp 355-356. Long-term prognosis for independent living is
  3. 3. poor. Those who have better outcome are those who had some language skills before the age of five, tested with a higher IQ, and who have no history of seizures. The following disorders are related to Autism, but show a different developmental course and pattern of symptoms: Rett’s Disorder: rare disorder only occurring in females, due to a gene mutation; onset in first four years; normal first year, then a slowing down in head growth and a decline in motor and communication skills; then a social withdrawal, stereotypic and repetitive hand or finger movements or whole body movements; mental retardation; persistent and progressive Childhood Disintegrative Disorder: normal development for first two years; typical onset between three and four years; loss of skills in at least two of the following: expressive or receptive language, social skills or adaptive behaviors, bowel or bladder control, play, and motor skills; other symptoms similar to autism noted; etiology unknown • Asperger’s Disorder: latest onset of the disorders: preschool or later; associated with less severe deficits; impairment in social interactions, repetitive patterns of behavior, limited interests; failure to make eye contact; inexpressive facial expressions; mechanical and robotic body posture and gestures; few friends, no interest in recreation or humor; may be a milder form of autism; more common in males; may be gifted in certain areas Asperger’s Disorder A. Qualitative impairment in social interactions, as manifested by at least two of the following: 1. 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
  4. 4. 2. failure to develop peer relationships appropriate to developmental level 3. 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 to other people) 4. lack of social or emotional reciprocity B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: 1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal either in intensity or focus 2. apparently inflexible adherence to specific, nonfunctional routines or rituals 3. stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements) 4. persistent preoccupation with parts of objects PDD-NOS: Not Otherwise Specified: a catch-all category when the child displays “autistic-like behaviors and developmental delays, but doesn’t meet the criteria for any of the above disorders