Transcript Autism and Autism Spectrum Disorders

Autism and
Autism Spectrum Disorders
Professor Graham Martin OAM
Director Child and Adolescent Psychiatry
The University of Queensland
Autism
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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
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Both verbal and non-verbal, with relative lack of speech,
repeated words, phrases or patterns
Limited Social Interactions
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Poor eye contact and difficulty interacting
Difficulties expressing emotions
Poor perception of how others think and feel
Repetitive Behaviours
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repeating words or actions
obsessively following routines
Causes of Autism
Genetic
 12 or more genes on different chromosomes may be
involved
 Genes may
 make a person more susceptible to impact of (say)
infection
 directly cause specific symptoms
 determine severity of symptoms
Likely Chromosomes and Genes
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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
disorders
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Fragile X Syndrome
Tuberous Sclerosis, Phenylketonuria (PKU)
Rett Syndrome
Other possible causes
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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:
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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.
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Failure to develop peer relationships appropriate to
developmental level
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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)
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Lack of social or emotional reciprocity
Diagnostic Criteria (2)
Qualitative impairments in communication as
manifested by at least one of the following:
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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:
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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:
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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
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Overly sensitive to touch (may have a tactile
defensiveness)
Under-responsive to pain
Senses may be affected to a lesser or greater
degree
No real fear of dangers
Play
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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
Behaviours
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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
Assessment
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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
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Full audiological assessment, lead screen if
pica present
CHAT, MCHAT
Autism Screening Q
Australian Scale for Asperger’s Syndrome
then refer for intervention and autism specific
assessment
Specific Autism evaluation
Diagnostic Parental Interviews
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Gilliam Autism Rating Scale (GARS)
Parent Interview for Autism
The Pervasive Developmental Disorders
Screening Test ( PDDST)
Autism Diagnostic Interview- Revised (ADIR)
Diagnostic Observation
Instruments
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The Childhood Autism Rating Scale (CARS)
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The Autism Diagnostic Observation Schedule
(ADOS)
Intervention
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There is no cure for autism.
Treatment and education approaches may
reduce some challenges associated with the
disability.
Intervention may lessen disruptive behaviours.
Education can teach self-help skills for greater
independence.
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
keyboards)
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
sleep
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:
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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
Children
 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
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Children with autism exhibit a significant
delay in language skills
Children with Asperger’s have only mild
impairments or peculiar ways of using
language
Diagnostic Features of Asperger’s
Social Interactions
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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
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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
him/herself
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
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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
goals
Limited Interests and
Preoccupations
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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
shunned
Friends interested in similar things
Jobs in areas of interests
Pragmatic Disorder
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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
Tests
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Test of Pragmatic Language
Test of Problem Solving
Effective Strategies to Teach
Pragmatic Language
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Social Language Groups
Social Language Stories
Reciprocal Conversation with Therapist
Role Playing
Videotaping
Coaching During Social Times
Language Disorder
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Sometimes language learning is precocious
There must be words by 2 years and phrases by 3
years
Style of learning language may be like an autistic
child: echolalia, difficulty learning pronouns,
difficulty understanding verbal explanations
Tests
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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
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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
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COMPROMISING
If you compromise, you are doing the right
thing.
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.
Resources
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www.ocali.org
www.autism-society.org