Transcript Autism Spectrum Disorder

Autism Spectrum Disorder
ECED 2060
Disability Category Presentation
1943 – Dr. Leo Kanner
• Johns Hopkins
University Hospital
• 11 patients with
similar
characteristics
• Coined term “early
infantile autism”
Dr. Hans Asperger
• About the same time
as Dr. Kanner in
USA
• Germany
• Described a milder
form of autism, now
known as “Asperger
Syndrome”
NOW called AUTISM
SPECTRUM DISORDER
• Five separate disorders in the spectrum
• Formerly called Pervasive Developmental
Disorders
• DSM IV lists 5; but closely related is
childhood schizophrenia
IDEA Definition of AUTISM
• “Autism means a developmental
disability significantly affecting verbal
and nonverbal communication and
social interaction, generally evident
before age 3, that adversely affects
educational performance.
Characteristics of autism include
irregularities and impairments in
communication, engagement in
repetitive activities and stereotyped
movements, resistance to
environmental change or change in
daily routines, and unusual responses
to sensory experiences.”
THE FIVE DISORDERS
of Autism Spectrum Disorder
• AUTISTIC DISORDER
• RETT SYNDROME
• CHILDHOOD DISINTEGRATIVE
DISORDER
• PERVASIVE DEVELOPMENTAL
DISORDER- NOT OTHERWISE
SPECIFIED (PDD-NOS)
• ASPERGER SYNDROME
Autism Spectrum Disorder
Statistics
• Estimated ~ 1 per 150 children (1/94
boys)
• Generally reliably diagnosed by age 3
• Sometimes apparent much earlier
• Deficits in social interaction, verbal and
nonverbal communication, and
repetitive behaviors and interests
Possible Indicators . . .
• Does not babble, point, or make meaningful
gestures by age 1
• Does not speak one word by 16 months
• Does not combine 2 words by 2 years
• Does not respond to name
• Loses language or social skills
• No big smiles or other warm, joyful
expressions by 6 months of age
• No back and forth sharing of sounds, smiles,
or other facial expressions by 9 months
Some other possible
indicators
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Poor eye contact
Doesn’t seem to know how to play with toys
Compulsively lines up toys or objects
Is attached to one particular toy or object
Doesn’t smile
At times seems to be hearing impaired
No gesturing, such as pointing, showing,
reaching, waving by 12 months
• No pretend play by 18 months
More indicators . . .
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Stiff, or resistant to hugs or to cuddling
Seldom seeks comfort or responds to anger
Difficulty regulating emotions
Repetitive, self-stimulating motions, such as handflapping, head banging …
Extreme reaction to changes in environment or
schedule
At ANY age, loss of speech, babbling, motor skills
Acute sensitivity to touch, taste, noise, smells
Odd use of the eyes
AUTISTIC DISORDER
• Four times more
common in boys
• Moderate to severe
• Many also have
mental retardation
• Sometimes referred
to as childhood
autism or early
infantile autism
RETT SYNDROME
• Neurological disorder
• Caused by a defective
regulatory MECP2 gene,
found on the X
chromosome.
• Gene discovery announced
10/1/99 by scientists at
Baylor College of Medicine.
• Lifespan ~ 47 years . . .
Rett Syndrome, continued
• Occurs 1 in 10,000 to 1
in 23,000 female births
• First discovered by Dr.
Andreas Rett in 1964.
• Development normal
until 6 – 18 months,
followed by loss of
speech and hand skills,
slowing of head growth,
and development of
stereotyped hand
movements . . .
Rett Syndrome, continued . .
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Seizures
Breathing irregularities
Scoliosis
Teeth grinding
Poor circulation
Trouble sleeping
Irritability
Difficulty chewing and
swallowing
• Trembling
Childhood Disintegrative
Disorder
• Fewer than 2 per
100,000 children
diagnosed with ASD
could be classified as
having CDD.
• Two or more years of
apparently normal
development
• Average age of onset
3—4 years
• Strong male
preponderance
CDD, continued . . .
• Extensive and
pronounced losses in
motor, language, and
social skills
• Loss of bowel and
bladder control
• Usually accompanied by
severe mental
retardation
• Often accompanied by
seizures
Pervasive Developmental Disorder –
Not Otherwise Specified (PDD-NOS)
• According to the DSM IV, this diagnosis should
be used “when there is a severe and pervasive
impairment in the development of social
interaction and verbal and nonverbal
communication skills, or when stereotyped
behaviors, interests and activities are present,
but the criteria are not met for a specific
Pervasive Developmental disorder,
schizophrenia, Schizotypal Personality Disorder,
or Avoidant Personality Disorder.”
PDD-NOS . . .
• . . . In other words,
sounds like ASD, tastes
like ASD, but doesn’t
quite fit any other part
of ASD . . .
• No set criteria in DSM IV
for diagnosing PDD-NOS
• No medical test available
• Diagnosis usually a
clinician’s ‘best guess’
Asperger Syndrome
• Also referred to as
Asperger’s
Syndrome or
Asperger’s Disorder
• Mildest of the five
disorders in the
spectrum
• Incorrectly called
“high-functioning
autism” sometimes
Indicators of Asperger
Syndrome
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Lack of social skills
Poor coordination
Poor concentration
Normal intelligence
Adequate language skills
Repetitive and
stereotyped behaviors
Other disorders with
symptoms that mirror Autism
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William Syndrome
Landau-Kleffner Syndrome
Attention Deficit Disorder
Language disorders, such
as apraxia and hyperlexia
Mobius syndrome
Joubert syndrome
Down Syndrome
CHARGE syndrome
Smith-Lemli-Opitz
syndrome
Other disorders …
• Fragile X Syndrome:
Most common form of
inherited mental
retardation – affects 2% to
5% of children with ASD.
• Tuberous Sclerosis: a
rare genetic disorder that
causes benign tumors to
grow in the brain and other
organs. 1% to 4% of
children with ASD also
have this.
• Angelman Syndrome,
Prader-Willi
Syndrome (both due
to problems on
chromosome pair 15) –
some children with
autism also have
problems on
chromosome 15. The
disorders also have
symptoms similar to
autism.
Problems That May
ACCOMPANY autism
• Sensory problems:
generally highly sensitive
to sounds, textures,
tastes, smells, etc. (see
next slide)
• Mental Retardation:
Many have some degree
of mental impairment
• Epilepsy: One in four
children with ASD
develops seizures; also
risk for abnormal EEG
without seizures.
• Learning disabilities:
mainly in cognition tasks
• Tics: ~9% of children
with autism.
• Sleep disorders: 50%
to 70% of children with
autism.
• Gastrointestinal
symptoms
• Psychiatric conditions
Sensory Symptoms -- AUDITORY
• Difficulty processing
auditory information
• Central Auditory
Processing Disorder
(CAPD) – difficulty
discriminating foreground
from background noise;
distortions of speech
sounds, lag time in
processing speech
Sensory Symptoms – VISUAL
• Visual perceptual
problems, such as tunnel
vision, reliance on
peripheral vision, difficulty
telling foreground from
background
• Sensitivity to light
• Inability to focus on
changing visuals
• Visual overload
• Inability to look and listen
at the same time
Sensory Symptoms – SMELL and
FOOD ALLERGIES
• Because of sensitivity to
smell some children with
ASD may refuse to eat
certain foods, go to a
zoo, sit in the cafeteria,
go to a farm, etc. Other
odors may trigger
sensitivities.
• Children with autism are
more likely than the
average child to have
food allergies.
Sensory Symptoms -- TOUCH
• One of the earliest signs
of autism is observed in
babies who scream when
they are touched or
hugged.
• Light touch may be painful
• Touch may cause anxiety
• Clothing can feel torturous
• Deep pressure is tolerated
very well
• Self-stimulating behaviors
Some theories on the cause
of AUTISM . . . 1. Bettelheim
• Mother’s extreme
hatred for the child –
her wish that he/she
would just die.
• “Refrigerator mothers”
and absent fathers
• --Dr. Bruno Bettelheim
Some theories on the cause
of AUTISM . . . 2. Child’s Diet
• Food allergies maybe
• Insufficiency of certain
vitamins maybe
• Sugar, or fat, or
carbohydrates maybe
• Gluten-free and caseinfree diet nice solution??
• Vitamin B6 taken with
magnesium to cure???
• Secretin, a cure???
Some theories on the cause of
AUTISM . . . 3. vaccinations
• THIMEROSAL, a mercurybased preservative used in
the measles-mumps-rubella
(MMR) vaccine
• Not used in US vaccines
anymore.
• Therapies such as Lauana
Lei (magnetic clay bath)
therapy to extract mercury
from body
Some theories on the cause
of AUTISM . . . 4. Brain . . .
• Abnormal brain
development beginning
in the infant’s first
months.
• Caused by genetic
defects in brain growth
factors
• Sudden, rapid head
growth – early warning
signal
• Not verified nor
discredited to date
Some theories on the cause of
AUTISM . . . 5. Genetic Predisposition
• Researchers have discovered a
genetic predisposition to ASD,
which “interacts with an as-yetunknown environmental factor
or factors and causes
alterations to the immune
system, the sensory nervous
system, the brain, and often the
gastrointestinal tract as well.”
• (Cure Autism Now)
Some theories on the cause of
AUTISM . . . 6. brain inflammation
• Recent research at Johns
Hopkins School of
Medicine suggests that
autism may be related to
brain inflammation, and
further, the brain’s
immune system may be
triggered by factors
“possibly including birth
complications, diet,
toxins, or infections.”
Some theories on the cause of
AUTISM . . . 7. Nitric Oxide
• A BBC report on this
study (previous page)
adds that “another study
found raised levels of
nitric oxide in the plasma
of children with autism.
The chemical plays a role
in the immune response,
and is known to affect
neurodevelopmental
processes.
Medications sometimes used
for ASD
• Selective serotonin reuptake
inhibitors (prozac, fluoxetine,
etc.) (anxiety and depression)
• Antipsychotic medications
(haloperidol, thioridazine, etc.)
(behavioral problems)
• Anticonvulsants (Tegretol,
Lamictal, etc.) (seizures)
• Stimulant medications (Ritalin,
etc.) (inattention and
hyperactivity)
Other treatments . . .
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Early intervention
Special Education
Diets
Neurotransmitter
manipulation (serotonin,
dopamine, epinephrine)
• Clay Baths
• Facilitated Communication
(next) (and then after that)
• Applied Behavior Analysis
FACILITATED
COMMUNICATION
• Started in Australia in
1970s
• Facilitator supports
client’s hand, wrist, or
arm
• Client touches alphabet
blocks to spell out words
• Much controversy
• Class activity
Applied Behavior Analysis
• Developed by Ivar
Lovaas
• Calls for “intensive,
one-on-one childteacher interaction for
40 hours a week”
• Goal to reinforce
desirable behaviors and
reduce undesirable
ones
Other hopeful interventions
• Developmental/Individual
Difference Model – finding where
the child differed from the norm
and getting him/her back on track
• Dr. Stanley Greenspan developed
“Floor Time” – purposeful
intervention enmeshed in play
• Social Story – ways that children
can learn the social cues that they
are missing taught to the child in a
story
And more . . .
• Therapeutic Horseback Riding (Hippotherapy)
– promotes sensory integration, coordination,
balance, and communication
• Auditory Intervention Training Strategies –
Alfred Tomatis developed an electronic ear
that modulates sound for the child with
autism.
• Music Therapy – physical and emotional
outlets
• Touch – deep massages, or “Squeeze
Machine” (invented by Temple Grandin)
which applies constant deep pressure to the
body
AND FINALLY . . .
• Recreation Therapy – Relaxation
and enjoyment; leisure activities;
can include direct instruction,
peer mentors, etc.
• Gluten-free, casein-free diets
• Anti-yeast diets
• Mercury detoxification
• Vitamin B6
• Secretin
Sources of Information
• Autism: A Project Life Book 2005, funded by Missouri
Department of Mental Health
• http://www.nas.org.uk
• http://www.athealth.com
• http://home.coqui.net
• http://www.specialfamilies.com
• http://www.nytimes.com
• “Human Exceptionality: School, Community, and
Family” by M. L. Hardman, C. J. Drew, & M. W. Egan
(2006)
• “The Exceptional Child: Inclusion in Early Childhood
Education” by K. E. Allen and G. E. Cowdery (2005)