AUTISM

Overview

What is Autism?Is there more than one type of Autism?What causes Autism?How is Autism diagnosed?What are the characteristics of Autism?What are the most effective approaches to treating Autism? Is there a cure?

WHAT IS AUTISM?

Very complex, often baffling developmental disabilityFirst described by Leo Kanner in 1943 as early infantile autism“Auto” – children are “locked within themselves.”For next 30 years, considered to be an emotional disturbance

WHAT IS AUTISM?

Today, autism is a severe form of a broader group of disordersThese are referred to as pervasive developmental disordersTypically appears during the first 3 years of life

WHAT IS AUTISM?Very likely neurological in origin – not emotional, not the refrigerator momPrevalence figures vary widely earlier: 5/10,000, but recent data say as high as 1/1000 or even 1/500. 4 times more prevalent in boysNo known racial, ethnic, or social boundariesNo relation to family income, lifestyle

WHAT IS AUTISM?

Autism impacts normal development of the brain in areas of social interaction and communication skills.Difficult to communicate with others and relate to the outside world.Occasionally, aggressive and/or self-injurious behavior may be present.

WHAT IS AUTISM?

May exhibit repeated body movements (hand flapping, rocking).Unusual responses to peopleAttachment to objectsResistance to change in routineSensory sensitivities

WHAT ARE THE TYPES?

Actually, the “umbrella” heading is Pervasive Developmental Disorder (PDD).Autism is one of the 5 PDDs.All have commonalities in communication and social deficitsDiffer in terms of severity

1. Autistic Disorder

Impairments in social interaction, communication, and imaginative play.Apparent before age 3.Also includes stereotyped behaviors, interests, and activities

2. Asperger’s Disorder

Impairments in social interactions, and presence of restricted interests and activitiesNo clinically significant general delay in languageAverage to above average intelligence

3. Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)

Often referred to as atypical autismUsed when a child does not meet the criteria for a specific diagnosis, but there is severe and pervasive impairment in specified behaviors

4. Rett’s Disorder

Progressive disorder which, to date, has only occurred in girls.Period of normal development and then the loss of previously acquired skillsAlso loss of purposeful use of hands, which is replaced by repetitive hand movementsBeginning at age of 1-4 years

5. Childhood Disintegrative Disorder

Normal development for at least the first 2 yearsThen significant loss of previously acquired skills

Conclusions on TypesAutism is a spectrum disorderThis means that symptoms and characteristics can present themselves in wide variety of combinations, from mild to severeAutistic individuals can be very different from each other“Autism” is still commonly used to refer to any of the 5 PDDs

What causes (and doesn’t cause) autism?

Good agreement in general that autism is caused by abnormalities in brain development, neurochemistry and genetic factorsSome of the research indicates a variety of things including: Exposure to heavy metals

Environmental issuesLyme Disease, etc.

Yet there is no proof that any one of these areas is truly responsible for Autism. Another scenario is that there have always been many children with Autism, but the diagnosis hasn't been there like it is now.Bettlelheim’s theory of psychogenesis?

How is Autism Diagnosed?No definitive medical testTeam uses interviews, observation, and specific checklists developed for this purpose.Team might include neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, etc.Must rule out MR, hearing impairment, behavior disorders, or eccentric habits

CHARACTERISTICS

1. Communication/Language2. Social Interaction3. Behaviors4. Sensory and movement disorders5. Resistance to change (predictability)6. Intellectual functioning

1. Communication/language

Broad range of abilities, from no verbal communication to quite complex skillsTwo common impairments:

A. Delayed languageB. Echolalia

A. Delayed language

50% of autistic individuals will eventually have useful speech (?)Pronoun reversal: “You want white icing on chocolate cake.”Difficulty in conversing easily with othersDifficulty in shifting topicsLook away; poor eye contactFacilitated communication?

Elements of Facilitated Communication

1. Physical Support2. Initial training/introduction3. Maintaining focus4. Avoiding competence testing5. Generalization6. Fading

B. Echolalia

Involuntary parrot-like repetition (echoing) of a word or phrase just spoken by another person. Common in very young children (Age 3)Immediate or delayedIs there communicative intent with echolalia?

2. Social InteractionOne of hallmarks of autism is lack of social interaction1. Impaired use of nonverbal behavior2. Lack of peer relationships3. Failure to spontaneously share enjoyment, interests, etc. with others4. Lack of reciprocity

Theory of mind?

3. Behaviors

Repetitive behaviors, including obsessions, tics, and perseverationImpeding behaviors (impede their learning or the learning of others)Will need positive behavior supportsA. Self-injurious behaviorB. Aggression

4. Sensory and movement disorders

Very commonOver- or under-sensitive to sensory stimuliAbnormal posture and movements of the face, head, trunk, and limbsAbnormal eye movementsRepeated gestures and mannerismsMovement disorders can be detected very early – perhaps at birth

5. Predictability

Change in routine is very stressfulMay insist on particular furniture arrangement, food at meals, TV showsSymmetry is often importantInterventions need to focus on preparing students for change if possible

6. Intellectual functioning

Autism occurs in children of all levels of intelligence, from those who are gifted to those who have mental retardationIn general, majority of individuals with autism are also identified as having mental retardation – 75% below 70Verbal and reasoning skills are difficultSavant syndrome

Interventions

1. Individualization and early intervention are the keys2. Include life skills, functional academics, and vocational preparation3. Positive behavior support4. Social stories (music therapy?)5. *Lovaas model

*Behavioral intervention program developed in the Psychology Department of UCLA under the direction of Dr. O. Ivar Lovaas.

Facts and Statistics •1 in 150 births <1> Only 20 years ago the statistics were 1 in 10,000.•4:1 ratio of boys to girls •1 in 98 boys •1 to 1.5 million Americans <2> •Fastest-growing developmental disability10 - 17 % annual growth •$90 billion annual cost <3> •90% of costs are in adult services <3> •Cost lifelong care can be reduced by 2/3 w/ early diagnosis/intervention <3> •In 10 years, the annual cost will be $200-400 billion <4>

1.Based on prevalence statistics from the Centers for Disease Control and Prevention (2007). 2.Based on the autism prevalence rate of 2 to 6 per 1,000 (Centers for Disease Control and Prevention, 2001)

and 2000 U.S. Census figure of 280 million Americans. 3.Jarbrink K, Knapp M, 2001, London School of Economics study: "The economic impact on autism in

Britain," 5 (1): 7-22. 4.ASA calculates that the annual cost of autism will increase to $200-400 billion in 10 years. February 2003

There are more than 500,000 individuals under the age of 21 with some form of Autism right now in the United States.

Facts and Statistics cont.•More children will be diagnosed with autism this year than cancer, diabetes, Downs Syndrome and AIDS combined. •Autism receives less than 5% of the research funding of most of the more prevalent childhood disorders.

Incidence vs. Private Funding (2007)

Condition Incidence Private Funding Pediatric AIDS 1 in 8,000 394 Million Leukemia 1 in 25,000 310 Million Muscular Dystrophy 1 in 20,000 175 Million Juvenile Diabetes 1 in 500 130 Million Autism 1 in 150 42 Million

Autism OrganizationsOregonOregon:

Autism Society of Oregon USAUSA:

Asperger and Autism Information by MAAP Services Autism National Committee (AUTCOM/ANC) Autism Network International (ANI) Autism Society of America Autism Speaks Center for the Study of Autism Families for Early Autism Treatment (FEAT) of Northern CaliforniaSociety for Auditory Integration Training