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  1. 1. AUTISM <ul><li>Dr shabeel pn </li></ul>
  2. 2. Overview <ul><li>What is Autism? </li></ul><ul><li>Is there more than one type of Autism? </li></ul><ul><li>What causes Autism? </li></ul><ul><li>How is Autism diagnosed? </li></ul><ul><li>What are the characteristics of Autism? </li></ul><ul><li>What are the most effective approaches to treating Autism? Is there a cure? </li></ul>
  3. 3. WHAT IS AUTISM? <ul><li>Very complex, often baffling developmental disability </li></ul><ul><li>First described by Leo Kanner in 1943 as early infantile autism </li></ul><ul><li>“ Auto” – children are “locked within themselves.” </li></ul><ul><li>For next 30 years, considered to be an emotional disturbance </li></ul>
  4. 4. WHAT IS AUTISM? <ul><li>3 categories for autism in IDEA? </li></ul><ul><li>Today, autism is a severe form of a broader group of disorders </li></ul><ul><li>These are referred to as pervasive developmental disorders (later) </li></ul><ul><li>Typically appears during the first 3 years of life </li></ul>
  5. 5. WHAT IS AUTISM? <ul><li>Very likely neurological in origin – not emotional, not the refrigerator mom </li></ul><ul><li>Prevalence figures vary widely (textbook says 5/10,000, but recent data say as high as 1/1000 or even 1/500. </li></ul><ul><li>4 times more prevalent in boys </li></ul><ul><li>No known racial, ethnic, or social boundaries </li></ul><ul><li>No relation to family income, lifestyle </li></ul>
  6. 6. WHAT IS AUTISM? <ul><li>Autism impacts normal development of the brain in areas of social interaction and communication skills. </li></ul><ul><li>Difficult to communicate with others and relate to the outside world. </li></ul><ul><li>Occasionally, aggressive and/or self-injurious behavior may be present. </li></ul>
  7. 7. WHAT IS AUTISM? <ul><li>May exhibit repeated body movements (hand flapping, rocking). </li></ul><ul><li>Unusual responses to people </li></ul><ul><li>Attachment to objects </li></ul><ul><li>Resistance to change in routine </li></ul><ul><li>Sensory sensitivities </li></ul>
  8. 8. WHAT ARE THE TYPES? <ul><li>Actually, the “umbrella” heading is Pervasive Developmental Disorder (PDD). </li></ul><ul><li>Autism is one of the 5 PDDs. </li></ul><ul><li>All have commonalities in communication and social deficits </li></ul><ul><li>Differ in terms of severity </li></ul>
  9. 9. 1. Autistic Disorder <ul><li>Impairments in social interaction, communication , and imaginative play . </li></ul><ul><li>Apparent before age 3. </li></ul><ul><li>Also includes stereotyped behaviors, interests, and activities </li></ul>
  10. 10. 2. Asperger’s Disorder <ul><li>Impairments in social interactions, and presence of restricted interests and activities </li></ul><ul><li>No clinically significant general delay in language </li></ul><ul><li>Average to above average intelligence </li></ul>
  11. 11. 3. Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) <ul><li>Often referred to as atypical autism </li></ul><ul><li>Used when a child does not meet the criteria for a specific diagnosis, but there is severe and pervasive impairment in specified behaviors </li></ul>
  12. 12. 4. Rett’s Disorder <ul><li>Progressive disorder which, to date, has only occurred in girls. </li></ul><ul><li>Period of normal development and then the loss of previously acquired skills </li></ul><ul><li>Also loss of purposeful use of hands, which is replaced by repetitive hand movements </li></ul><ul><li>Beginning at age of 1-4 years </li></ul>
  13. 13. 5. Childhood Disintegrative Disorder <ul><li>Normal development for at least the first 2 years </li></ul><ul><li>Then significant loss of previously acquired skills </li></ul>
  14. 14. Conclusions on Types <ul><li>Autism is a spectrum disorder </li></ul><ul><li>This means that symptoms and characteristics can present themselves in wide variety of combinations, from mild to severe </li></ul><ul><li>Autistic individuals can be very different from each other </li></ul><ul><li>“ Autism” is still commonly used to refer to any of the 5 PDDs </li></ul>
  15. 15. What causes (and doesn’t cause) autism? <ul><li>Good agreement in general that autism is caused by abnormalities in brain development, neurochemistry, and genetic factors </li></ul><ul><li>Bettleheim’s theory of psychogenesis ? </li></ul>
  16. 16. How is Autism Diagnosed? <ul><li>No definitive medical test </li></ul><ul><li>Team uses interviews, observation, and specific checklists developed for this purpose. </li></ul><ul><li>Team might include neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, etc. </li></ul><ul><li>Must rule out MR, hearing impairment, behavior disorders, or eccentric habits </li></ul>
  17. 17. CHARACTERISTICS <ul><li>1. Communication/Language </li></ul><ul><li>2. Social Interaction </li></ul><ul><li>3. Behaviors </li></ul><ul><li>4. Sensory and movement disorders </li></ul><ul><li>5. Resistance to change (predictability) </li></ul><ul><li>6. Intellectual functioning </li></ul>
  18. 18. 1. Communication/language <ul><li>Broad range of abilities, from no verbal communication to quite complex skills </li></ul><ul><li>Two common impairments: </li></ul><ul><li>A. Delayed language </li></ul><ul><li>B. Echolalia </li></ul>
  19. 19. A. Delayed language <ul><li>50% of autistic individuals will eventually have useful speech (?) </li></ul><ul><li>Pronoun reversal : “You want white icing on chocolate cake.” </li></ul><ul><li>Difficulty in conversing easily with others </li></ul><ul><li>Difficulty in shifting topics </li></ul><ul><li>Look away; poor eye contact </li></ul><ul><li>Facilitated communication?????? </li></ul>
  20. 20. Elements of Facilitated Communication <ul><li>1. Physical Support </li></ul><ul><li>2. Initial training/introduction </li></ul><ul><li>3. Maintaining focus </li></ul><ul><li>4. Avoiding competence testing </li></ul><ul><li>5. Generalization </li></ul><ul><li>6. Fading </li></ul>
  21. 21. B. Echolalia <ul><li>Common in very young children (Age 3) </li></ul><ul><li>Immediate or delayed (even years) </li></ul><ul><li>Is there communicative intent with echolalia? </li></ul>
  22. 22. 2. Social Interaction <ul><li>One of hallmarks of autism is lack of social interaction </li></ul><ul><li>1. Impaired use of nonverbal behavior </li></ul><ul><li>2. Lack of peer relationships </li></ul><ul><li>3. Failure to spontaneously share enjoyment, interests, etc. with others </li></ul><ul><li>4. Lack of reciprocity </li></ul><ul><li>Theory of mind? </li></ul>
  23. 23. 3. Behaviors <ul><li>Repetitive behaviors , including obsessions, tics, and perseveration </li></ul><ul><li>Impeding behaviors (impede their learning or the learning of others) </li></ul><ul><li>Will need positive behavior supports </li></ul><ul><li>A. Self-injurious behavior </li></ul><ul><li>B. Aggression </li></ul>
  24. 24. 4. Sensory and movement disorders <ul><li>Very common </li></ul><ul><li>Over- or under-sensitive to sensory stimuli </li></ul><ul><li>Abnormal posture and movements of the face, head, trunk, and limbs </li></ul><ul><li>Abnormal eye movements </li></ul><ul><li>Repeated gestures and mannerisms </li></ul><ul><li>Movement disorders can be detected very early – perhaps at birth </li></ul>
  25. 25. 5. Predictability <ul><li>Change in routine is very stressful </li></ul><ul><li>May insist on particular furniture arrangement, food at meals, TV shows </li></ul><ul><li>Symmetry is often important </li></ul><ul><li>Interventions need to focus on preparing students for change if possible </li></ul>
  26. 26. 6. Intellectual functioning <ul><li>Autism occurs in children of all levels of intelligence, from those who are gifted to those who have mental retardation </li></ul><ul><li>In general, majority of individuals with autism are also identified as having mental retardation – 75% below 70 </li></ul><ul><li>Verbal and reasoning skills are difficult </li></ul><ul><li>Savant syndrome </li></ul>
  27. 27. Interventions <ul><li>1. Individualization and early intervention are the keys </li></ul><ul><li>2. Include life skills, functional academics, and vocational preparation </li></ul><ul><li>3. Positive behavior support </li></ul><ul><li>4. Social stories (music therapy?) </li></ul><ul><li>5. Lovaas model </li></ul>