Autism and Autism Spectrum Disorders by y00syRb8


									       Autism and
Autism Spectrum Disorders
    Professor Graham Martin OAM
      Director Child and Adolescent Psychiatry
           The University of Queensland

   A severely disabling condition that develops in first 3
    years of life
   Occurs approx 1 in every 5-600 births
   More common in boys (4:1)
   Features vary from child to child, and differ in
    severity from child to child
   No influence from ethnic, racial, social factors,
    income, lifestyle or parental educational levels
                Common Features
Communication problems
   Both verbal and non-verbal, with relative lack of speech,
    repeated words, phrases or patterns

Limited Social Interactions
   Poor eye contact and difficulty interacting
   Difficulties expressing emotions
   Poor perception of how others think and feel

Repetitive Behaviours
   repeating words or actions
   obsessively following routines
             Causes of Autism
 12 or more genes on different chromosomes may be

 Genes may

    make a person more susceptible to impact of (say)

    directly cause specific symptoms

    determine severity of symptoms
       Likely Chromosomes and Genes
   Chromosome 2
   Chromosome 7
   Chromosome 13
   Chromosome 15
   Chromosome 16
   Chromosome 17
   The X Chromosome
   HOXA1
   HOXD1
   Gamma-amino-butyric acid (GABA) pathway genes
   consensus that it is Polygenetic (>10)
                 Other Causes
24% of cases overlap other genetic medical
     Fragile X Syndrome
     Tuberous Sclerosis, Phenylketonuria (PKU)
     Rett Syndrome
Other possible causes
     in utero rubella
     encephalopathy
     cytomegalovirus
             Diagnostic Criteria
6 items; at least 2 from (1), 1 each from (2) & (3)

(1) Qualitative impairment in social interaction, as manifested
  by at least two of the following:
  Marked impairment in the use of multiple non verbal
  behaviors such as eye- to- eye gaze, facial expression, body
  postures, and gestures to regulate social interaction.
  Failure to develop peer relationships appropriate to
  developmental level
  A lack of spontaneous seeking to share enjoyment, interests,
  or achievements with other people (e.g., by lack of showing,
  bringing, or pointing out objects of interest)
  Lack of social or emotional reciprocity
            Diagnostic Criteria (2)
Qualitative impairments in communication as
 manifested by at least one 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 such as gesture or mime)
   In individuals with adequate speech, marked impairment in the
    ability to initiate or sustain a conversation with others.
   Stereotyped and repetitive use of language or idiosyncratic
    language, or copying of language (Echolalia)
   Lack of varied, spontaneous make- believe play or social
    imitative play appropriate to developmental level.
            Diagnostic Criteria (3)
Restricted repetitive and stereotyped patterns of
  behavior, interests and activities, as manifested by at
  least two of the following:
   Encompassing preoccupation with one or more stereotyped
    and restricted patterns of interest that is abnormal either in
    intensity or focus.
   Apparently inflexible adherence to specific, nonfunctional
    routines or rituals
   Stereotyped and repetitive motor mannerisms (e.g. hand or
    finger flapping or twisting or complex whole body movements
    or copying of movements (Echopraxia)
   Persistent preoccupation with parts of objects.
              Diagnostic Criteria
B. Delays or abnormal functioning in at least one of the
  following areas, with onset prior to age three years:
   Social interaction
   Language as used in social communication or
   Symbolic or imaginative play

C. Not better accounted for by Rett disorder or
 childhood disintegrative disorder.
              Sensory Changes
   Overly sensitive to touch (may have a tactile
   Under-responsive to pain
   Senses may be affected to a lesser or greater
   No real fear of dangers
   Lack of social interaction in play - which is
    more solitary
   Lack of spontaneous or imaginative play
   Does not imitate others‟ actions
   Does not initiate pretend games
   Sustained odd play
   Overactive or Passive
   Temper tantrums for no apparent reason
   May perseverate on a single item, idea, person
   Apparent lack of common sense
   May show aggression or violent behaviours
   May injure themselves deliberately for no apparent reason
   May spin objects, line things up, organize
   Inappropriate attachment to objects
   Unresponsive to normal teaching methods
   Insistence on sameness; resists change in routine
   Uneven gross/fine motor skills (may not can kick ball but can
    stack chairs)
    Absolute Indications For ASD
   No babbling, or pointing, or other gestures by
    12 months
   No single words by 16months
   No 2-word spontaneous phrases by 24 months

   any loss of any language
   any loss of social skills at any age
       Specific Screen for Autism
   Full audiological assessment, lead screen if
    pica present
   Autism Screening Q
   Australian Scale for Asperger‟s Syndrome

then refer for intervention and autism specific
      Specific Autism evaluation
    Diagnostic Parental Interviews

   Gilliam Autism Rating Scale (GARS)
   Parent Interview for Autism
   The Pervasive Developmental Disorders
    Screening Test ( PDDST)
   Autism Diagnostic Interview- Revised (ADI-
        Diagnostic Observation

   The Childhood Autism Rating Scale (CARS)

   The Autism Diagnostic Observation Schedule
   There is no cure for autism.
   Treatment and education approaches may
    reduce some challenges associated with the
   Intervention may lessen disruptive behaviours.
   Education can teach self-help skills for greater
   Intervention needs to be tailored to the
    individual, and their family
           Behaviour Therapy
Most widely used and successful method is intensive
 behavioural intervention (IBI)

“We believe that behavior modification carried out in
  systematic, highly individualized, daily programming
  is the best overall approach now available to persons
  with autism” (Graziano, )
            Team Approach
Speech therapy
 Helps in developing communication skills
  which may include alternative forms of
  communication (sign language and the use of

Occupational Therapy
 Addresses specific needs for daily living
              Team Approach
Art and music therapy can be used to increase
  communication skills, social interaction, and a sense
  of accomplishment.

Medication may be necessary to control behaviour or

Dietary assessment is important - a balanced diet as far
  as possible but with extra vitamins and/or minerals.
  people with autism are more susceptible to allergies
  and food sensitivities than the average person. The
  most common food sensitivity in children with autism
  is to gluten and casein.
        Autism Spectrum Disorder
May have to consider:
   Autism
   Asperger‟s Syndrome (AS)
   Tourette‟s Syndrome (TS)
   Landau Kleffner‟s Syndrome (LKS)
   Rett Syndrome
   Attention Deficit/Hyperactivity Disorder (AD/HD)
   Specific Learning Disabilities (SLD)
   Childhood Disintegrative Disorder (CDD)
   Prader Willi Syndrome
   Fragile-X Syndrome
   PKU
   Hurler‟s Syndrome
   Cornelia de Lange Syndrome
   William‟s Syndrome
        Asperger’s Syndrome

Original report:
“Autistic Psychopathies in Childhood” (1944)
translated into English in 1980
     Asperger’s Observations
 Find it difficult to „fit in‟ socially

 Have poor social use of language

 Have limited ability to use and understand

  gestures and facial expressions
 Use repetitive, stereotypical behaviors

 Have abnormal fixations on certain objects/

  areas of interest
 Are vulnerable to teasing and bullying
         Asperger’s Syndrome
A pervasive developmental disorder characterized by:
    Impairment of two-way social interaction and
     general social ineptitude
    Speech which is odd/pendantic, stereotyped in
     content, but which is not delayed
    Adherence to rules, routines, rituals

    Lack of social reciprocity

    Limited non-verbal communication skills – little
     face expression or gestures
   Generally equated with high functioning autism.
     Distinctions between Asperger’s
          Syndrome and Autism

   Children with autism exhibit a significant
    delay in language skills
   Children with Asperger‟s have only mild
    impairments or peculiar ways of using
           Diagnostic Features of
Social Interactions
      Socially aloof, unconcerned
      Inappropriate eye contact (but usually present)
      Peer friendships occur, but may lack strategies to develop
       or maintain
      Difficulty taking the perspective of another person
      May often lack empathy
      Blatantly honest or straight-forward even when not in
       their best interest
      Tense and distressed when trying to cope
           Social Communication
   Superficially perfect spoken language
   May lack voice expression, difficulty interpreting different
    tones of voice
   Difficulty interpreting and using non-verbal communication,
    body language, gestures, facial expressions
   May take things in a very literal way
   May fail to grasp implied meanings of language
   May not easily grasp social rules or subtleties
   May talk at length about topics that are of interest to only
   Uses objects in an atypical fashion
   Insists that others do things according to their own prescribed
    order and rules
         Poor Problem Solving and
           Organizational Skills
   Difficulties in…
      Situations requiring “common sense”

      organizing thoughts and abstract reasoning

      Transitioning from one situation to another

   Deficits in…
      mental planning

      Impulse control

      Self monitoring

   Strong desire for orderliness may delay achieving
            Limited Interests and
   May talk at length about topics that are of
    interest to only him/herself
   Redirects conversations back to topics of
    interest even at risk of being ridiculed or
   Friends interested in similar things
   Jobs in areas of interests
             Pragmatic Disorder
   Lack of understanding about the reciprocity of
    verbal and nonverbal communication
   Decreased understanding and use of gestures
   Decreased use of questions
   Difficulty maintaining a conversation

   Test of Pragmatic Language
   Test of Problem Solving
    Effective Strategies to Teach
        Pragmatic Language
   Social Language Groups
   Social Language Stories
   Reciprocal Conversation with Therapist
   Role Playing
   Videotaping
   Coaching During Social Times
             Language Disorder

   Sometimes language learning is precocious
   There must be words by 2 years and phrases by 3
   Style of learning language may be like an autistic
    child: echolalia, difficulty learning pronouns,
    difficulty understanding verbal explanations

   Preschool Language Scale-4
   Clinical Evaluation of Language
   The Test of Language Development
   Expressive One Word Vocabulary Test
   Peabody Picture Vocabulary Test
          Language Test Scores
         Show an Unusual Profile
   Highest scores are in expressive vocabulary,
   Next highest are in receptive vocabulary,
   Next are in grammatical structures,
   Often below average are tests of problem solving,
   Lowest area is in pragmatic language skills.
             Teach Flexibility
   If you compromise, you are doing the right
   Compromise means letting the other person
    have his way.
   If you do this, you get a bonus point.
             Teach Flexibility
                   BEING BOSSY
 Often turn other children off by being bossy,
  controlling and judgmental.
 So, they lose a point (or a turn) for teasing
  criticizing another child.
 Alternately, they get extra points for saying
  something nice.
 If the child starts out saying several nice things,
               he is not teased as much.

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