The document discusses autism spectrum disorders and the multidisciplinary team approach utilized by the UCLA Center for Autism Research and Treatment, focusing on understanding origins, diagnostics, and effective treatments. It highlights the importance of early identification and intervention, detailing diagnostic criteria, screening methods, medical evaluations, and psychiatric co-morbidities associated with autism. Additionally, it outlines various interventions tailored for children, adolescents, and adults with ASD to improve social skills, communication, and overall quality of life.

1. THE ABC’S OF AUTISM:
A MULTIDISCIPLINARY TEAM
APPROACH TO
UNDERSTANDING AUTISM
SPECTRUM DISORDERS
Semel Institute for Neuroscience and Human Behavior
University of California, Los Angeles

2. Who we are:
• UCLA Center for Autism Research and Treatment (CART)
• Our research goals:
• To understand the origins of the social, communicative, and language
deficits demonstrated by individuals with autism
• To develop new and more effective treatment for autism spectrum
disorders
• UCLA Child and Adult Neurodevelopmental (CAN) Clinic
• Our clinical service goals:
• To provide comprehensive diagnostic evaluations and treatment
recommendations utilizing a multidisciplinary team approach
• To expand treatment service options across the lifespan from infancy to
adulthood

3. Our Team Tonight (in order of appearance):
• Amanda Gulsrud, PhD: Clinical psychologist
• Shafali Jeste, MD: Neurologist
• Sunil Mehta, MD: Psychiatrist
• Connie Kasari, PhD: Educational psychologist
• Enjey Lin, PhD: Clinical psychologist

4. Contact information:
• For more information about CART and to participate in
research:
▫Website: http://www.semel.ucla.edu/autism
▫Phone: 310-825-9041
▫Email: info@autism.ucla.edu
▫ For more information about CAN and our menu of service
options:
▫Website: http://www.semel.ucla.edu/autism/clinic
▫Phone: 310-794-4008
▫Email: mlazar@mednet.ucla.edu

5. THE ABC’S OF AUTISM:
EARLY RISK AND
DIAGNOSIS
Amanda Gulsrud, PhD
Semel Institute for Neuroscience and Human Behavior
University of California, Los Angeles

6. Neurodevelopmental disorders
•Autism spectrum disorder
(ASD)
•Intellectual disability (ID)
•Global developmental delay
(GDD)
•Attention Deficit
Hyperactivity Disorder
(ADHD)
•Social Communication
Disorder
• Heterogeneous conditions
characterized by a delay or
disturbance in the acquisition of
skills in a variety of developmental
domains: motor, social, language,
cognition (APA, 2013)
• Highly comorbid
• Severity quantified by level of
adaptive/functional impairment

7. Diagnoses based on “Best clinical estimate”
(1)clinical evaluation combined with
(2)standardized testing as needed
--combination of caregiver report and child evaluation
(1) Clinical evaluation guided by the
Diagnostic and Statistical Manual of
Mental Disorders (DSM):
DSM-5 published May 2013
*Classification of mental disorders,
provides criteria sets to guide the
process of diagnosis
*Revised periodically based on new
knowledge about disorders
(2) Standardized tests:
Autism Diagnostic Observation
Schedule (ADOS)—structured play
based assessment
Autism Diagnostic Interview (ADI)
—structured caregiver interview
Vineland Adaptive Behavior
Scales – caregiver questionnaire
about adaptive function (activities
of daily living)

8. Impaired
Communication
Repetitive
behaviors and
restricted
interests
Impaired
Social
Communicati
Impaired social
interaction
on
DSM-5: Autism Spectrum Disorder
A. Persistent deficits in social communication and
social interaction across contexts
A. Restricted, repetitive patterns of behavior,
interests, or activities
A. Symptoms present in early developmental
period
A. Symptoms limit/impair everyday functioning
B. Symptoms not better explained by ID or GDD.
Changes from DSM-IV:
1. ASD replaces categorical diagnoses of autistic disorder, PDD-NOS,
Asperger
2. Social and communication combined into one domain
3. RRB category includes sensory aversions and atypicalities
4. No strict age minimum for symptom presentation

9. Early identification of
risk/screening
 Studies report some behavioral differences as early as 12 months of
age (less initiating and responding to joint attention, less requesting,
more object focused)
 AAP recommends developmental surveillance and use of screening
measures at the child’s 12, 18 and 24 month office visits
 Screening tools validated at age 18 months
 M-CHAT
 PDDST-II
 Autism Screening Questionnaire
Early identification  Early intervention  Improved outcomes

10. Red Flags
• No big smiles by six months
• No back-and-forth sharing of sounds, smiles or other
facial expressions by nine months
• No babbling or communicative gestures by 12 months
• No words by 16 months
• No meaningful, two-word phrases (not including
imitating or repeating) by 24 months
• Any loss of speech, babbling or social skills at any age

11. Referrals
• Contact your family doctor or pediatrician for
further evaluation and referral
• Contact your local regional center
• http://www.dds.ca.gov/RC/
• Autism Speaks website for further resources
• www.autismspeaks.org

12. Behavioral Interventions can begin
early!
• Community-based programs are seeing children as young
as 18 months of age
• UCLA Clinical Services and Research:
• The Early Childhood Partial Hospitalizations Program (ECPHP)
• Early Intervention Study for children 12-22 months of age at-risk for
ASD

13. THE ABC’s of Autism:
Medical Workup and
Neurological
Comorbidities of Autism
Spectrum Disorders
Shafali Spurling Jeste, MD
Semel Institute for Neuroscience and Human Behavior
University of California, Los Angeles

14. Recommended medical workup for ASD
• Genetics: karyotype, fragile X, MECP2 mutation testing,
chromosomal microarray analysis (soon: whole exome
sequencing!)
• MRI only if abnormal neurological exam or global developmental
delay
• EEG only if concern for seizures or language regression

15. Why Genetics?
(1) Several single gene disorders
show high rates of autism:
-Fragile X syndrome: 1-2%
-Tuberous Sclerosis: <1%
(30-50% have autism)
-Rett syndrome: <1%
(2) Now finding more copy
number variants (CNVs)
-small duplications or deletions
in the chromosomes
-at least 20% of ASD associated
with a CNV

16. Epilepsy
• More than one unprovoked seizure in a lifetime
• Diagnosed by clinical events and also by EEG
(electroencephalogram)
• EEG picks up brain activity (firing of neurons) at the surface of the
scalp

17. Epilepsy in ASD
• Known since the first reported case of autism
• Abnormal EEG’s reported in up to 50%
• Epilepsy reported in around 30%
• No primary seizure type
• Two peaks: early childhood and adolescence
• Many genetic disorders associated with both ASD and
epilepsy
• More common in girls with ASD

18. Epilepsy in ASD: Workup & Treatment
• If any concern obtain 24 hour EEG:
• Abnormal spells (staring, involuntary movements)
• Developmental regression (especially language regression)
• Major change in behavior or sleep patterns
• Medications depend upon type of seizure
• There are no medications that are specifically better for
children with ASD
• However, side effects do exist that need to be considered
for each child

19. Sleep impairment in ASD is COMMON
Most common complaint is insomnia (=not enough sleep)
>80% of children with ASD
Diagnosed with parent questionnaires and sleep studies
Delayed sleep onset
Nighttime awakenings
Early morning awakenings
Reduced “need” for sleep
“Good sleepers” show less: affective problems, inattention/hyperactivity,
restricted/repetitive behaviors and better social interaction than “bad sleepers.”

20. Diagnosis of sleep
impairment
• Gold standard for identifying sleep problems is overnight
sleep study (actigraphy)
• Polysomnogram (PSG): records EEG, eye movements, heart
rate, blood pressure, blood oxygenation, respirations
• Can be challenging to obtain in children with ASD
• Thus, studies often rely on questionnaires and reports

21. Treatment for insomnia
• Behavioral intervention is the first line treatment:
• Establish a regular sleep routine
• Set realistic goals and make gradual changes
• Medications:
• Melatonin is most well studied
• Clonidine
• Mirtazapine
• Anti-epileptics can be sedating
• Lavender, chamomile, valerian root

22. Melatonin
• produced exclusively by pineal gland
• Effective for some patients
• Mechanisms of action are unclear
• NOT regulated by the FDA

23. When should you see a neurologist?
• Concerns about developmental regression
• Concerns about seizures
• Autism plus global developmental delay
• Motor problems
• Sleep problems (at least for consultation)
• Need for a thorough neurological examination
• Known genetic syndrome or variant associated with ASD

24. THE ABC’S OF
AUTISM:
PSYCHIATRIC CO-MORBIDITIES
AND
THE ROLE OF
MEDICATION IN ASD
Sunil Mehta, MD
Semel Institute for Neuroscience and Human
Behavior
University of California, Los Angeles

25. Financial Disclosures
• None

26. As if Autism wasn’t enough…..
• Psychiatric diagnoses are collections of symptoms
• Intellectual Disability
• Attention Deficit/Hyperactivity Disorder; Learning
Disorders
• Depression/Bipolar Disorder
• OCD/Anxiety disorder

27. What medication can and can’t do
• No medication, so far, has been able to change the core
symptoms of ASD
• The FDA has approved 2 medications for use in ASD,
Risperidone and Aripiprazole.
• The one behavioral symptom that these medications
improve is self-injurious behavior/violence or aggression
towards others.
• Commonly used psychiatric medications can be effective
in treating co-morbidities, but…..

28. Be prepared for a bumpy ride
• People with ASD are more likely to have side effects from
commonly used psychiatric medications and these side
effects happen at lower doses than in neurotypical
children.
• For mood symptoms/anxiety, people with ASD are less
likely to respond to the first medication they try, so they
will probably need to try multiple medications.

29. Supplements and Herbal
medications
• Vitamin E, Omega-3 fatty acids, fish oil have been
studied, data is inconclusive. Hyperbaric oxygen, heavy
metal chelation, gluten-free diets have been studied and
were found to have no effect.
• Mega-doses (>5 times USDA recommended daily
allowance) of vitamins has never been proven to help in
any disease.
• PLEASE tell your doctor about supplements and herbals,
even if you think he/she won’t agree with you.

30. THE ABC’S OF AUTISM:
Interventions for Children with
ASD
Connie Kasari, PhD
Semel Institute for Neuroscience and Human Behavior
University of California, Los Angeles

31. Going to school with ASD
▫ Most children spend 5-6 hours per day in school
▫ Treatments for ASD are often incorporated in school
▫ Disconnect between ‘therapy’ and ‘school’
▫ Goal is that all therapies can be under one umbrella (e.g.,
school) but this may not always be possible

32. Early Intervention Models
• There are multiple evidence-based models of early
intervention for autism
• Most programs are based on behavioral principles
• Therapists work on behaviors that are important to
individual’s functioning, such as:
• Reducing behaviors such as tantrums, aggression, self-stimulation,
perseverative behaviors
• Increasing language, social skills, play skills, joint
attention and emotional recognition

33. Preschool

34. Minimally verbal 5 – 8 year olds
Communication Interventions in
Schools with iPad
Results positive for SGD in
addition to behavioral intervention

Kasari et al, JAACAP, 2014

35. Older children need social skills
Develop friendships at school Working on peer relationships

36. Materials for Teachers/Playground Assistants
Specific playground intervention: Remaking Recess

37. Social menus to encourage
chatting at lunch time

38. Paraprofessionals can improve child engagement on
the playground (6 weeks)
(Kretzmann, Shih & Kasari, 2014)

39. THE ABC’S OF AUTISM:
INTERVENTIONS FOR
ADOLESCENTS AND ADULTS
WITH ASD
C. Enjey Lin, PhD, BCBA-D
Semel Institute for Neuroscience and Human Behavior
University of California, Los Angeles

40. Unique and Ongoing Needs
• Transition between adolescence to young adulthood is recognized as a crucial period
• Slowing of improvement post-high school (particularly those without ID)
• Change in educational structure and resources after high school
• +50% low rates of engagement in vocational or educational activities
• Co-occurring psychiatric conditions are common in ASD (e.g., anxiety or depressive
disorders)
• Complicates outcomes (e.g., quality of life, engagement in daily activities,
employment)
• Greater cognitive and verbal abilities can be risk-factor
• Across all ability levels, teens and adults with ASD struggle
• Under- or un-involved in education or work = 30% attended college and only up to
50% had regular employment-- lower rates compared to other disabilities (e.g.,
language delays)
(Hallett et al., 2013; Taylor et al., 2012; Shattuck et al., 2014; Smith et al., 2012; White et al., 2014)

41. Types of Interventions
• Development is life-long process & environment makes a difference
• Disconnect, lack of treatments and resources
• Behavioral interventions:
• Across the age-span
• Areas-- communication, behavioral concerns, daily living, & social functioning
• Cognitive behavioral interventions:
• Reduce anxiety & depressive disorder (high verbal and cognitive abilities)
• Skill-building in core ASD areas & coping skills
• Social skills group interventions:
• Focus on building and practicing skills
• Friendships and interpersonal skills* in the work setting
(Bonete et al., 2014; Dawson & Burner, 2011; McGillivray & Evert, 2014; White et al., 2014; Lin & Wood, 2010; Valenti et al.,
2010; Wood et al., in press; Yoo, Laugeson, et al., 2014)

42. Interventions (continued)
• Independent/adaptive living skills treatment:
•Housekeeping, personal care, community living & social skills
•Poorer skills = Poorer outcomes
• Vocational training:
•Vocational engagement & independence = reduced ASD symptoms &
challenging behaviors, and increased adaptive functioning
•Supported work/integrated programs (job coach) vs sheltered work
setting programs = quality of life and cognitive functioning
•Room for improvement
(Garcia-Villamisar et al., 2002 & 2007; Shattuck et al., 2014; Taylor et al., 2013)

43. Some Available Resources
• Behavior agencies in the community
• Autism Spectrum Therapies
• STAR of California
• Vocational Training/Independent Living Programs
• Department of Rehabilitation Services & Regional Centers
• Supported employment services vs work activity program services
• Advance LA
• FACT in Los Angeles
• Child and Adult Neurodevelopmental Clinic
• Individual treatment, group treatment for enhancing independence and treating
anxiety/mood, medication treatment
• Social Skills Intervention
• UCLA PEERS Social Skills Program for Adolescents and Young Adults
• Educational Programs
• UCLA Pathways Program

44. Thank you