Transcript Autism Spectrum Disorders Through the Lifespan

Autism Spectrum Disorders
Judith Miller, Ph.D.
Department of Psychiatry
University of Utah
[email protected]
Educational Objectives
► Overview
of ASD characteristics
► Discuss diagnostic issues
► Briefly touch on:
 Early identification
 Adult outcomes
 Causes and treatments
What is ASD? What is PDD?
= Pervasive Developmental Disorder
► the general diagnostic category in which
autism, Asperger Disorder, and PDDNOS
fall
► all involve deficits in social relatedness,
communication, and behaviors & interests
► Terms ASD and PDD are largely
synonymous
► PDD
DSM-IV Classification System
Pervasive
Developmental Disorders
Autistic
Disorder
Asperger
Disorder
Rett
Disorder
Childhood
Disintegrative
Disorder
PDDNOS
Autism Spectrum Disorders
Autism Spectrum
Disorders
Autistic
Disorder
Asperger
Disorder
PDDNOS
Terms that might be used
interchangeably
► Autism,
Autistic Disorder
► High functioning autism (i.e., a diagnosis of
autism made in a verbal individual with
normal IQ)
► Asperger Disorder
► PDDNOS
► Autism spectrum disorder
► “autistic features”
Symptoms of ASD
► Social
difficulties
 Difficulty using or understanding nonverbal
communication (eye contact, facial expression,
body language)
 Difficulty making friends
 Difficulty sharing their interests with others
appropriately
 Difficulty with emotional reciprocity
Symptoms of ASD (cont.)
► Communication
Impairments
 Delayed speech development
 Difficulty with reciprocal conversations
 Unusual language (repeats dialogue from
movies, uses rote phrases)
 Difficulty with imaginary or social play
Symptoms of ASD (cont.)
► Restricted
Behaviors
or Repetitive Interests or
 Preoccupation or narrow interests (e.g.,
memorizes facts about train schedules or
dinosaur habits)
 Repetitive hand or body movements
 Difficulty with change/insistence on
nonessential routines
 Overly drawn to sensory activities
Diagnostic Differentiations
►
Autistic Disorder
 6 or more of the 12 possible symptoms, can include individuals of
any intellectual or verbal level
 “High functioning autism” means Autistic Disorder in a person who
is verbal and not intellectually impaired
►
Asperger Disorder
 5 or fewer symptoms, must not have had delays in language or
cognitive development (High functioning by definition)
►
PDDNOS
 ASD symptoms but full criteria for autism or Asperger not met
(fewer symptoms, atypical presentation, or developmental course
not yet clear)
Reliability of diagnosis
v. non ASD is reliable
► Distinctions between forms of ASD (autism, HFA,
AS, PDDNOS) are not as reliable
► If the diagnoses cannot be reliably distinguished
from each other by “autism experts,” validity of
the proposed differences is called into question
► ASD v. non ASD may be a more helpful distinction
► ASD
Differential Diagnosis
► hearing
impaired
► general DD/MR
► speech-language
disorders
► psychotic/early
schizophrenia
► OCD
 Specific Language ► selective mutism
Impairment
► abuse/neglect
 Central Auditory Processing
► oppositional-defiant disorder
Disorder
► personality disorders (in
► ADHD
adults)
► learning disabled
Common Comorbidities
► MR
► ADHD
► mood
disorders
► anxiety disorders
► ASD
generally makes other comorbidities
more difficult to manage
Diagnostic measures
► Best
information comes from clinical observations
and developmental history
 Autism Diagnostic Observation Schedule (Western
Psychological Services)
 Autism Diagnostic Interview – Revised (Western
Psychological Services)
► Screeners
are available, but have significant
limitations and should be used with caution
 Be sure that the test is appropriate for the individual’s
verbal and cognitive level
 Be aware that most screeners underidentify
► Practice
parameters referenced below
Early Identification
► Recent
emphasis on identifying autism as
early as possible (i.e. at onset if possible)
► Research includes:
 Retrospective studies of home videos
 Prospective studies of infant siblings
 Toddler screening studies
► Clinical
experience suggests:
 Brief evaluation is insufficient; some children
look quite interactive in first 10-20 minutes
Early Warning Signs
► Not
responding to name
► Limited imitation skills
► Difficulty with pretend play
► Difficulty with joint attention (pointing
things out to people just to share a social
interaction)
► Library of early signs at
www.autismspeaks.org
Adult Outcomes
► Individuals
with IQ <70 generally have poor
adult outcomes
► Individuals with IQ>70 have variable
outcomes, from poor to very good
 For HFA/AS, outcome does not necessarily
improve as IQ gets higher
► Individuals
who were verbal at age 5 are
more likely to have a good outcome, but not
guaranteed
What Causes Autism?
► Short
answer: We don’t know
► Long history of hypothesized causes,
including poor parenting, vaccines, yeast,
vitamin deficiency, etc.
► Strong evidence for a genetic component
► Probably poly-genetic, with variable
penetrance
What treatment is effective?
► Short
answer: Behavioral teaching (aka “Applied
Behavioral Analyses”) has been shown to improve
IQ scores, reduce behavior problems, and increase
functional living skills
► Other ways of teaching skills and addressing
problems can be effective
► Many biomedical or alternative treatments have
become available, often based on anecdotal
evidence not supported by larger studies
Resources for further information
► General
information
 www.autismspeaks.org
 www.aspergersyndrome.org
 www.cdc.gov
Resources (cont.)
► Practice
Parameters
 Volkmar et al., (1999). Practice parameters for the
assessment and treatment of children, adolescents, and
adults with autism and other pervasive developmental
disorders. J Am Acad Child Adolesc Psychiatry 38 (suppl
12) 32S-54S.
 Filipek et al., (2000). Practice parameter: Screening
and diagnosis of autism. Neurology 55:468-479.
 CA Dept of Developmental Services (2002). Autistic
spectrum disorders: Best practice guidelines for
screening, diagnosis, and assessment. Available at:
www.ddhealthinfo.org/asd.asp