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Autism Spectrum Disorders

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					Autism Spectrum Disorders

Autism and Asperger’s Syndrome

                      Julie K. Ivey
                    Baylor University


Presentation at the 1st Annual Texas Wide Underwriting Conference
   Autism Spectrum Disorder
A condition affecting the processing, integrating,
 and organization of information that significantly
    impacts communication, social interaction,
  functional skills, and educational performance.

There are many manifestations and degrees of
      severity within the autism spectrum.
What characteristics do you
think of when you hear the
      word AUTISM?
    Discussion Video:

http://www.youtube.com/watch?v
=FDMMwG7RrFQ&feature=related
   Fragile – Handle with Care

 Even though there are many things about me that are
unique, in the ways that really matter I am just like
other children. I learn best from people I trust, and I
learn to trust when I sense that people like me. Please
try to see the world through my eyes, for I can’t see it
through yours. And please know that even though it
may not seem so, I really am trying to adapt to a world
that my neurological challenges prevent me from
understanding without your help. If you keep these
things clearly in mind, you will more likely be able to
teach me the things I need to know so that I can
function with greater understanding and competence in
a world that is often inhospitable to my needs. (pg. xv)
  Leo Kanner’s description (1943)

Inability to relate   Extreme            Resistance to        Deficits in
to others             aloneness;         being picked up or   language, often
                      isolated from      held                 mutism
                      outside world

Some cases had        Early specific     Extreme fear         Obsessive desire
excellent rote        food preferences   reaction to loud     for repetition and
memory                                   noises               sameness


Few spontaneous       Bizarre and        Normal physical
activities (such as   repetitive         appearance
typical play)         physical
                      movements (such
                      as spinning and
                      rocking)
             What Do We Know?

   Autism is a spectrum disorder
   Children have varied but similar characteristics
   Children with autism may or may not have mental
    retardation
   ASD is a neurological disorder not psychological or
    environmental
   No known cure
   Diagnosis is based on Behavioral Criteria
   Life long disability
Autism affects…
                    Statistics
   Autism Spectrum Disorder 1:91 (CDC, Feb. 2010)
   Not respective of class
   3-5:1 boy/girl – females tend to have lower
    cognitive abilities
   ~75% MR
   Age 5 – general predictor of verbal language
   Seizures may develop in adolescence – usually
    lower IQ
                         Epidemic?
   Broader definition including PDD-NOS,
    Asperger’s Syndrome
   Closure of institutions
       Children left the institutions and entered schools and
        doctor’s offices
   Autism became categorical label for special
    education services (1991, IDEA)
   Increased recognition
       Professionals
       Public - media
             Clinical Features


   Early onset – usually before age 3
   Social dysfunction to include imaginative
    play
   Communication deficits
   Odd or unusual behaviors
                Social Dysfunction
   Theory of Mind – Inability to put self “in someone else’s
    shoes”
   Reduced joint attention – pointing, sharing
       Early predictor of ASD
   Lack of age appropriate peer relations
       Must be taught social skills
       May be indifferent to typical interest of peers
   Lack of social-emotional reciprocity
   Unaware of unwritten rules of social conduct
          Communication Deficits
   ~50% nonverbal – no attempt to compensate
    with gestures
   ~50% verbal-marked impairment in sustaining
    conversation
       Echolalia (immediate & delayed)
       Fails to attend to social cues or contextual cues
       Switches topics to those of interest to him/herself
       Continues topic of interest after other person has lost
        interest
       Interrupts conversations
         Odd/Unusual Behaviors
   Restricted interests – favorite toy/object (odd),
    lines up objects
   Interest is not usually the item but the category
    of item
   Stereotypic Behaviors - flapping, twirling,
    rocking, sniffing, toe walking, self-biting
   Adherence to routines – need for sameness –
    need to impose external order on an ever
    changing complex world
             Restricted Interests

   Children with autism do not have control over their
    interests just as neurotypical children can’t control
    their interests
      Typically developing kids can be “hooked” by
       socially mediated strategies
      Find “hooks” for kids with autism in their interests

   Restricted interests are a symptom of the disability
     Abnormal Sensory Response
   Sound – covers ears, melt down
   Vision – fascinated with lights, movements, gaze
    peculiarities
   Touch – differs; some love touch, others pull
    away; hypersensitivity to pain
   Taste – refusal generally due to texture, pica,
    some very restricted diet
                         Sensation

   All information is taken in through the senses
   Distorted sensory input among the 5 senses
      Touch: tactile defensiveness

           Light touch

           Sticky/gooey substances

           Often crave deep touch (pressure)

      Visual Perceptions

           Trouble judging distances – PE a problem

      Auditory impairments

           Frequency (pitch) and intensity (loudness)
Asperger’s Syndrome
            Clinical Features


   Later Diagnosis
   Social Dysfunction
   Communication Deficits
   Odd or Unusual Behaviors
              Later Diagnosis

   Language develops, or seems to develop
    normally
   IQ is normal or nearly normal
   Self help skills intact except social skills
   Curiosity about the environment
              Social Dysfunction

   Difficulty forming friendships
   The child truly wants to have friends and
    desires interaction with others but does
    not know how
       Often ridiculed
       Confusion
         Social Dysfunction, cont.

   Socially isolated
       Inappropriate or one sided conversations
       Expansive knowledge of odd topic
        i.e.: washing machines, trains, dinosaurs,
        statistics
       Knowledge dominates conversation and time
                 Pragmatics

   Appropriate topic but inappropriate
    comment
   Primary interest is to exchange factual
    information
   Literal interpretation
                  Prosody

   “Professor like”
   Inconsistent
   Emotion expressed in volume or pitch
       Odd or Unusual Behaviors
   Inflexible adherence to routine – becomes stressed or
    anxious
   Anxiety leads to pacing, withdrawal & possibly
    meltdowns
   Interests interfere with functioning
               Motor Issues

   Clumsy
   Poor balance, penmanship, difficulty with
    sports
      High Functioning Autism vs. Asperger’s
                    Syndrome

      HFA                         AS
serious social difficulties   serious social
                              difficulties
onset <3                       onset/diagnosis >3
language deficit              language “normal”
insistence on sameness        specific interests
motor skills early OK         motor skills clumsy
variable family history       + family history (dad)
Health Related Quality of Life
  Health in the United States has
  traditionally been measured
  narrowly and from a deficit
  perspective, often using measures
  of morbidity or mortality. But,
  health is seen by the public health
  community as a multidimensional
  construct1 that includes physical,
  mental, and social domains.
 Health Related Quality of Life

*Personal Level: Health risks and
conditions, functional status, social
support, and socioeconomic status.

*Community level: resources, conditions,
policies, and practices that influence a
population’s health perceptions and
functional status.
Quality of Life- Definition
Quality of life (QOL) is a broad
multidimensional concept that usually
includes subjective evaluations of both
positive and negative aspects of life.
What makes it challenging to measure
is that, although the term “quality of
life” has meaning for nearly everyone
and every academic discipline,
individuals and groups can define it
differently
Other Domains for QOL:
*jobs
*housing
*schools
*neighborhood
*culture
*values
*spirituality
What we know about Persons
        with ASD:
 Greater QOL=
 *Support (formal & informal)
 *Higher Intelligence (above 70)
 *Better communication skills
 *Live independently
 *Have job
 *Have relationships
            Assessment
*Team approach
*Deficits in:
     Social interaction
     Language as used in social
      communication
     Symbolic or imaginative play
         Treatments
ABA-  Applied Behavioral Analysis
TEACCH Method

Play Therapy

Floor Time

Educational/Collaborative

  Services
Diet

Medication

Others?
         Co-Morbidity:
1.   ADHD
2.   Mental Retardation
3.   Anxiety
4.   Obsessive Compulsive Disorder
5.   Motor Clumsiness
6.   Sensory Issues
7.   Seizures
                Families:
Family issues; parents tend to
          experience:
   Guilt
   Depression
   Shame
        Consider normal physical appearance
   Unrealistic expectations
        Consider splinter skills
     Video Examples:
   http://www.youtube.com/watch?v
    =p3n7Pm9UkJg&mode=related&s
    earch
   http://www.youtube.com/watch?v
    =yqcICjgp7oE&feature=related
   http://www.youtube.com/watch?v
    =R07LZwdQOPU&feature=related
            The Autism Paradox
   It’s easy to recite an entire book but
    difficult to make up a story
   It’s easy to line up toys but difficult to stay
    in line
   It makes perfect sense to climb on the
    sofa but little sense to sit on it
   Memorizing the presidents in order – 10
    minutes…Packing a school bag – 10 hours
   Family pictures on the wall ore boring but
    that speck of dust next to it, now that’s
    fascinating?
   Talking about weather patterns – piece of cake.
    Talking about my day…impossible!
   Ability to focus on spinning objects – timeless.
    Ability to focus on homework – 3 seconds
   Being called by name, can’t hear it. Some owl
    hooting in the distance – clear as a bell
   How to operate the remote control – zero
    instruction. How to button up pants – intensive
    instruction
   Navigating social rules – poorly skilled.
    Navigating from the back seat of the car – highly
    skilled
                Author unknown
                     References
   Eckenrode, L., Fennell, P., & Hearsey, K. (2005). Tasks
    Galore Making Groups Meaningful.
   Goldstein, Sam & Reynolds, Cecil R. (Eds.). (1999).
    Handbook of Neurodevelopmental and Genetic Disorders
    in Children. New York, NY: The Guilford Press.
   National Education Association. (2006). The puzzle of
    autism.
   Simmons, K. L. (2006). The official autism 101 manual.
    Alberta, Canada: Autism Today.
   Tilton, Adelle Jameson. (2004). The Everything Parent’s
    Guide to Children with Autism. Avon, MA: Adams Media
    Corporation.
   Twachtman-Cullen, D. (2006). How to be a Para Pro.
    Higganum, CT: Starfish Specialty Press, LLC.
   Volkmar, F. (2006, May). Asperger’s Disorder and
    Autism: An update on understanding and intervention.
    Presented by New England Educational Institute.

				
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