Transcript PowerPoint File

What is Autism?
Neurodevelopmental disorder with a spectrum of
clinical conditions
3 areas of dysfunction:
Social interaction/social relatedness difficulty
Communication impairment
Restrictive/repetitive behaviors and interests
Early intervention before the age of three is vital.
What about the patients we missed?
Undiagnosed prior to early intervention efforts
Patients with verbal abilities
Patients older than 3 years
How about that patient who has always seemed
peculiar?
Patients report significant relief even when diagnosis
is made later.
The Verbal Individual With Autism: Have You
Seen This Patient?
Adam: 8 year-old
Ryan: 23 year-old
Ethan: 13 year-old
Jeff: 35 year-old
Richard: 54 year-old
The Verbal Individual With Autism: Have You
Seen This Patient?
Listen to Parents
Are aware of the possibility of autism
Do have concerns when something is wrong
Do give accurate and reliable information about
their children
Need your questions to generate discussion about
their child’s development
The Verbal Individual With Autism: Have You
Seen This Patient?
Get History from
Parents
By school age:
Usually talking well and can enter school
May have stopped avoiding social contact and is at
least tolerant of it
May be socially awkward and socially immature
The Verbal Individual With Autism: Have You
Seen This Patient?
One sided
conversations
Over the next few years:
"Eccentricities" dominate his social interactions
A "little professor" on topics of special interest to him
When not talking about his interests, his social
interactions are immature or stilted
The child may interact with peers, although others may
perceive him as different
The Verbal Individual With Autism: Have You
Seen This Patient?
Poor social
understanding
As time passes and social demands increase:
May become anxious in social situations
Peers may reject him and he may become depressed
In school, he may be placed in learning support
classes because of social, behavioral or language
comprehension problems
He may be considered to have an attention problem or
obsessive compulsive behaviors
ASD Facts: Epidemiology
Conservative prevalence: 1 in 500; recent
estimates: 1 in 150
ASD more prevalent in pediatric population than:
Cancer
Diabetes
Downs Syndrome
Male to female ratio: 4 to 1
Autism Myths
Myth
Truth
Make no eye contact.
Look at or through you, but eye contact
has no social purpose.
Are not affectionate.
Are affectionate on their own terms.
Do not talk.
Can use advanced words, but they have
no function.
Do not point.
Usually develop the pointing skill later.
Are geniuses.
Can have intellectual functioning that
ranges from severe mental retardation to
normal intelligence.
Have no hope for
improvement.
Can experience positive outcomes with
early and intensive intervention.
ASD Causes:
Causation unknown
Strong genetic influence
Evidence supports
polygenic inheritance
Recurrence risk is 5-8% in
siblings
Autism does NOT
result from:
Poor parenting
MMR vaccine
Thimerosal preservative in
vaccines
ASD Facts
Present at birth, with onset of symptoms before 36
months
Accurate diagnosis possible at 18-24 months
Parents first voice concerns around 18 months, but
diagnosis is typically not until 3 years or older
Autism Spectrum Basics
Autism is a neurodevelopmental disorder with a
broad spectrum of behavioral manifestations
Autism is not rare! At 1 in 500, each pediatrician
should have up to 3 or 4 affected children in their
practice
Again, 3 Problem Areas
Delays or abnormalities in:
Social Interaction
Language Delay
Restricted or Repetitive Behavior
Social Symptoms
Lack of:
Use of eye contact to regulate social interaction
Orienting to name
Joint attention behaviors: pointing & showing
Pretend play
Imitation
Nonverbal communication
Language development
Language Delay – Need for immediate
referral
9 months:
12 months:
16 months:
24 months:
Any age:
No babbling
No pointing or other gestures
No single words
No functional 2-word phrases
(not echolalic)
Any loss of language or social
skills
Behavioral Red Flags
Investigate further and consider autism if the child:
Doesn’t know how to play with toys in a typical
fashion
Restricted patterns of interest
“Toe walks”
Has unusual attachments
Lines things up
Presents with sensory symptoms
Has odd movement patterns and/or very repetitive
behaviors
Demonstrates echolalia
Throws prolonged or frequent tantrums
Is hyperactive
0 – 3: Early Intervention
Different in each state
Babies Can’t Wait Programs
Autism Centers of Excellence
University Based Developmental Disorders
Check with State Office
Call 1-800-323-GROW for nearest CFC
Special Education
Mandated by federal IDEA legislation
Programs managed and vary by school district
Make referrals in writing!
Individualized Education Plan (IEP) for each child
Services for children with autism may include:
Speech therapy
Occupational therapy
Communication assistance (PECS)
Teacher education on classroom management
The Verbal Individual With Autism: Have You
Seen This Patient?
Long Term Planning
Later Years
Vocational and Occupation Training
Transition to adult healthcare providers
Long term care vs. Residential Placement
Estate planning