The document provides a history of autism including its original use by Bleuler in 1911 and further definition by Kanner in 1943. It discusses research and definitions by Asperger, Eisenberg, Creak, and Rutter that helped characterize autism. The Diagnostic and Statistical Manual of Mental Disorders (DSM) included autism for the first time in 1980 and further defined pervasive developmental disorders. The DSM-IV criteria require impairments in social interaction, communication, and repetitive behaviors. Prevalence of autism has increased since first measured in 1966, estimated now at 1 in 150 children. Boys are 4 times more likely to be affected than girls.

1. Overview of Autism

2. History of Autism
 Term autism originally used by Bleuler (1911)
 To describe withdrawal from social relations into a rich fantasy
life seen in individuals with schizophrenia
 Derived from the Greek autos (self) and ismos (condition)
 Leo Kanner – 1943
 Observed 11 children
 Inattention to outside world: “extreme autistic aloneness”
 Similar patterns of behavior in 3 main areas:
 Abnormal language development and use
 Social skills deficits and excesses
 Insistence on sameness

3. History of Autism
• Psychiatrist Hans Asperger (1944) - describes “little
professor” syndrome
 Eisenberg and Kanner (1956)
 Added autism onset prior to age 2
 Further refined definition of autism
 Creak (1961)
 Developed 9 main characteristics
 Believed they described childhood schizophrenia
 Incorporated into many descriptions of autism and commonly
used autism assessment instruments today

4. History of Autism
 Rutter (1968)
 Said the term autism led to confusion!
 Argued autism was different than schizophrenia
 Higher M:F ratio
 Absence of delusions & hallucinations
 Stable course (not relapse/marked improvement)
 Further defined characteristics (for science, research)
 National Society for Autistic Children
 One of the 1st & most influential parent groups for children with
autism in U.S.
 Wrote separate criteria (for public awareness, funding)
 Added disturbances in response to sensory stimuli & atypical
development
 Did not include insistence on sameness

5. Diagnostic and Statistical
Manual of Mental Disorders
 Published by the American Psychiatric Association
 Classification of mental disorders used in the US
 Infantile autism included for
first time in DSM-III
 Changed to autism in DSM-III-R
 DSM – IV published in 1994
 Text Revision in 2000

6. Pervasive Developmental Disorders
Come under section in DSM-IV-TR entitled…
 Disorders Usually First Diagnosed in Infancy, Childhood, or
Adolescence
 Include:
 Mental retardation
 Learning disorders
 Motor skills disorders
 Communication disorders
 Pervasive developmental disorders
 Attention-deficit and disruptive behavior disorders
 Feeding and eating disorders of infancy or early childhood
 Tic disorders
 Others: separation anxiety disorder, selective mutism, reactive
attachment disorder of infancy or early childhood, stereotypic
movement disorder, childhood, or adolescence - NOS

7. DSM Category: PDDs
Pervasive Developmental Disorders
Childhood
Autistic Rett’s
Disintegrative
Disorder Disorder
Disorder
PDD-
Asperger’s
Not Otherwise
Disorder
Specified
• PDDs are characterized by severe and pervasive impairment in 3 main areas
• Social interaction
• Communication
• Repetitive and restricted behaviors

8. Diagnostic Criteria for Autistic
Disorder (299.00)
To receive a diagnosis of autism, a child
must have at least 6 of the
characteristics in the 3 areas (note
minimums in each area)
 In one of the areas, onset must be
before age 3

9. DSM Criteria for an Autism
Diagnosis: Social Interaction
Must meet 2 of the following:
 Marked impairment in multiple nonverbal
behaviors (e.g., eye contact, facial
expressions)
 Failure to develop peer relationships for age
 Lack of spontaneous seeking to share
enjoyment, interests or achievement with
others
 Lack of social or emotional reciprocity

10. DSM Criteria for an Autism
Diagnosis: Communication
Must meet 1 of the following:
Delay in, or total lack of, the development of spoken
language (not accompanied by an attempt to
compensate through alternative modes of
communication)
Marked impairment in ability to initiate or sustain
conversation with others
Stereotyped and repetitive use of language
Lack of varied, spontaneous make-believe play or
social imitative play appropriate to developmental level

11. DSM Criteria for an Autism Diagnosis: Restricted
Repetitive and Stereotyped Patterns of Behavior,
Interests, and Activities
Must meet 1 of the following:
 Encompassing preoccupation
with one or more stereotyped
and restricted patterns of
interest that’s abnormal in intensity or focus
 Inflexible adherence to specific, non-functional
routines or rituals
 Stereotyped and repetitive motor mannerisms (e.g.,
hand flapping, rocking)
 Persistent preoccupation with parts of objects

13. DSM Criteria for PDD-NOS
• Severe and pervasive impairment in the
development of reciprocal social
interaction along with
• Communication skills OR
• Presence of stereotyped behavior,
interests, and activities
• But criteria are not met for any other
PDD

14. Rett’s Disorder

15. Childhood Disintegrative Disorder

16. What are ASDs?
• Autism Spectrum Disorders
• Continuum comprised of autism, Asperger’s,
and PDD-NOS (Volkmar & Klin, 2005)
• “the concept of autism is evolving from the
singular autistic disorder into the plural
autistic spectrum disorders (ASDs)”
(Filipek, 2005, p.535)
• Wing (1997) said that attempts to
differentiate b/w these disorders have
been “arbitrary…difficult to apply and
unhelpful in clinical practice” (p. 1761)

17. DSM V
• Proposed Revision of Autism Diagnosis
• http://www.dsm5.org/ProposedRevisions/P

18. Prevalence
 Terminology
 Incidence: the number of new cases of disease in a
defined group of people over a specific time
 Prevalence: the number of existing disease cases in a
defined group of people during a specific time period
 Prevalence of ASD has continued to increase since
first survey in 1966 – why?
 Increases in requests for service
 Changes in diagnostic criteria
 Increased assessment opportunities
 Better awareness by pediatricians, teachers, parents
 An actual increase in cases?

19. CDC Statistics
• Occur in all racial, ethnic, and socioeconomic
groups
• Four times more likely to occur in boys than
in girls
• Parents who have a child with an ASD have a
2%–8% chance of having a second child who
is also affected.

20. CDC Statistics - ASDs
 In 2003, 62% of the children who had an ASD had at least one
additional disability
 Of those children, 68% had mental retardation/intellectual
impairment
 8% had epilepsy – lower than previous
 In 1997, 18%-42%
 Other associated features
 Hyperactivity
 Short attention span
 Impulsivity
 Aggressiveness
 Self-injury
 Unusual responses to touch, smell, sound, and other sensory input.
 Abnormal eating habits (e.g., selectivity, pica)
 Abnormal sleeping habits.
 Abnormal moods or emotional reactions.
 Gastrointestinal issues such as chronic constipation or diarrhea

21. CDC Statistics - ASDs
• Some children with ASDs show hints of future problems within the
first few months of life.
• In others, symptoms may not show up until 24 months or later.
• Studies have shown that one third to half of parents of children with
ASDs noticed a problem before their child’s first birthday, and nearly
80%–90% saw problems by 24 months.
• Some children with ASDs seem to develop normally until 18–24 months
of age and then they stop gaining new language and social skills, or they
lose the skills they had.
• Children with ASDs develop at different rates in different areas of
growth.
• Splinter skills
• Delays in one area and age-appropriate in another and in some cases
even advances
• Inconsistent in how skills get developed
• Can read but can’t tell you what sound a “b” makes

22. CDC Statistics - ASDs
• Can often be detected as early as 18
months.
• But national average age of diagnosis is
between 4 and 5
• While all children should be watched to
make sure they are reaching developmental
milestones on time, children in high-risk
groups—such as children who have a parent
or brother or sister with an ASD—should
be watched extra closely…

23. Autism and Developmental Disabilities
Monitoring (ADDM) Network
• The ADDM Network is a group of programs funded by the Centers for
Disease Control and Prevention (CDC) to determine the prevalence of
ASDs in US communities.
• The ADDM Network’s first two ASD prevalence reports were released
• in the February 9, 2007, issue of the
Morbidity and Mortality Weekly Report Surveillance Summaries.
• 2000 6.7 per 1,000 for 8-yr olds
• 2002 6.6 per 1,000 8-yr olds
• That’s about 1 in 150 children in these communities
• The prevalence was much lower (3.3 per 1,000) in Alabama and
higher (10.6 per 1,000) in New Jersey in 2002. (About 1 in 94)
• Prevalence stayed the same from 2000 to 2002 in four of the six
sites with data for both years.
• It rose slightly in Georgia and significantly in West Virginia,
indicating the need for tracking prevalence over time.

24. New Prevalence Rates
• http://www.nytimes.com/2009/12/19/healt
• http://www.cdc.gov/ncbddd/autism/index.h

25. Current Prevalence Rates
 Nationwide
 One in 110 children is estimated to have
autism spectrum disorders nationwide.
 In Missouri:
 934 students diagnosed in 1997
 5,777 students in 2009
 Since 1992, autism prevalence has
increased at an average of 22% each
year

26. Prevalence of ASD has continued to
increase since first survey in 1966 –
why?
Increases in requests for service
Changes in diagnostic criteria
Increased assessment
opportunities
Better awareness by
pediatricians, teachers, parents
An actual increase in cases?

27. Ideally, what does the
diagnostic process look like?
 Assess all characteristics/abilities
 3 major areas, adaptive behavior, IQ
 Assess in multiple ways with multiple sources
 Interview, observation, checklist/rating scales
 Parent, teacher, professional examiner
 Assess over time with multiple observations in
multiple settings
 Home, school, daycare
 Structured, unstructured

29. Clinical vs. Educational Diagnosis
 Clinical diagnosis: conducted by psychologist,
neurologist, neuropsychologist
 Without a clinical diagnosis, a child may still qualify for
special ed services according to federal and state autism
disability definition
 Educational diagnosis: conducted by school
personnel, usually a team, consisting of people who
are familiar with the child.
 Definition of Autism drawn from the Individuals with
Disabilities Education Act (IDEA)
 Federal law which regulates eligibility, assessment, and
intervention of educational services for children with
disabilities

30. IDEA definition of Autism
 A developmental disability significantly affecting verbal
and nonverbal communication and social interaction,
generally evident before age 3, that adversely affects a
child's educational performance.
 Other characteristics often associated with autism are
engagement in repetitive activities and stereotyped
movements, resistance to environmental change or change
in daily routines, and unusual responses to sensory
experiences.
 The term does not apply if a child's educational
performance is adversely affected primarily because the
child has a serious emotional disturbance as defined below.

31. Etiology: Psychodynamic Theory
 Eve off (1960) – parents are cold, detached,
ritualistic
 Bruno Bettelheim (1967)
 Coined term “refrigerator mothers”
 No empirical support

32. Etiology: Genetic Evidence
 Strong evidence for genetic
component, but nature of the
component is unknown
 Does not look like a single gene
 Monozygotic twin concordance high,
but less than 100%

33. Etiology: Neurotransmitters
 Serotonin
 Some studies have found higher levels in
children with ASD
 Opioids
 Display properties similar to morphine
 Administration can result in stereotypy,
insensitivity to pain, reduced socialization
 Some studies have found higher levels in
children with ASD

34. Etiology: Vaccines
 http://scienceblogs.com/insolence/2010
 Warning!!!!

35. Etiology: Vaccines
 Vaccines
 Thimerosal - Preservative used in MMR vaccine used to contain
mercury
 Wakefield et al. (1998)
 12 children with PDD and gastrointestinal disease
 Purpose was to look at relationship b/w these
 Participants were selected b/c they had been referred to a
pediatric gastroenterology dept for tx of intestinal problems
(e.g., diarrhea, pain, bloating)
 Onset appeared to be near time of MMR vaccination
 Theory…MMR led to impaired intestinal functioning
 Permeability of the intestines increased
 Resulted in excess absorption of peptides from food
 The peptides have opioid effects
 Opioid excess led to brain dysfunction, and…
 Concluded that ASD was caused by MMR vaccine

36. Etiology: Vaccines
 Wakefield Study
 Methodological Issues
 Did not discuss specific diagnoses of participants (or how
obtained)
 The exact onset of intestinal problems was not known
 Evidence for link b/w behavior changes and MMR was based on
report
 Correlational study only
 Ethical Problems
 Financial and scientific conflicts that Dr. Wakefield did not
reveal in his paper.
 For instance, part of the costs of Dr. Wakefield’s research were
paid by lawyers for parents seeking to sue vaccine makers for
damages.
 Dr. Wakefield was also found to have patented in 1997 a
measles vaccine that would succeed if the combined vaccine were
withdrawn or discredited.

37. Etiology: Vaccines
 In 2004, 10 of the 13 authors on the
Wakefield et al. study published an article in
the same journal (The Lancet) retracting the
conclusions made in the original article
 http://www.childrensimmunisation.com/images/uploaded/D
 http://www.oregon.gov/DHS/ph/acd/flu/public/FluMMRau
 In 2010, the Lancet retracted the study
altogether
 http://www.nytimes.com/2010/02/03/health/research/03

38. Etiology: Vaccines
 Article on Autism and Vaccines
written by Catherine Maurice for
ASAT’s newsletter:
 http://asatonline.org/pdf/summer2009.pdf

39. Etiology: Vaccines
 In May, 2010, Lancet was banned
on practicing medicine in Great
Britain due to unprofessional
conduct
 http://www.nytimes.com/2010/05/25/healt
 http://www.aolhealth.com/2010/05/24/uk-b

40. Etiology
 CDC - Vaccines
 http://www.cdc.gov/ncbddd/autism/vaccines.htm
 ASAT – summary of the vaccine controversy
 http://www.asatonline.org/pdf/newsletter_preview.pdf
 Videos
 What Causes Autism?
 http://www.autismspeaks.org/video/index.php
 February (2009) court case
 http://www.cnn.com/2009/HEALTH/02/11/autism.vac

41. So…what’s the cause of autism?
 No one cause of autism has been identified
 Genetic influences are likely most important
risk factor
 But not only cause (MZ twin concordance < 100%)
 Cause is likely multifactorial
 Physiology and environment are ALWAYS
interacting from day 1
 May be several types of autism with different
causes