Transcript AUTISM SPECTRUM DISORDERS DIAGNOSIS AND TREATMENT …

AUTISM SPECTRUM DISORDERS
DIAGNOSIS AND TREATMENT
OPTIONS
BY
DR (MRS) E.A.E. ALUKO
MB BS FWACP, DAAP
Autism
• Defined as a Behavioral Disorder
Characterized by Treatable
Medical Problems
Autism
• Impairments in communication
• Problems with social interactions
• Repetitive, restrictive or stereotyped
behaviors
• Consider the concept of Autisms
Autism as a genetic syndrome
There are some classic genetic syndromes that
are characterized by autistic behavior
William’s syndrome
Cri du Chat
Rett’s syndrome
BUT
Classic Genetics Cannot Explain Increased Illness In
Children
•
Increase Over the Past 20 Years
- Autism: 6000% increase
* 1:1000 ---------- 1/50
* ADHD
400% increase
* Asthma
300% increase
* Allergies
400% increase
Paradigm for understanding Autism
Genetic Susceptibilities
Environmental triggers
Timing & Development
OVERVIEW
• Introduction
• What are ASD
• Who are the qualified professionals for
diagnostic assessments
• Diagnostic criteria for medical diagram.
AUTISM SPECTRUM DISORDERS
• Developmental Disability not visible at birth
• Different Brain Structure
complex genetic interaction
• Complex Disorder
many areas affected
• Wide Range of Impairment
mild to severe across areas
ASD STATISTICS
• Estimates 1 in every 110 children for
spectrum
• Present before the age of 3, but diagnosis
often later
• Found in all cultures and economic groups
• Four times more common in boys
3 AREAS AFFECTED
• Reciprocal Social Interactions
• Communication
• Behaviors and Interests
- Development in these areas follows a
DIFFERENT path than that of most
children
- Differences are QUALITATIVE
ASD
or
PDD
A SPECTRUM
1.Asperger’s Disorder
2.Atypical Autism/PDD-NOS
3.Austistic Disorder
4.Rett’s Disorder
5.Childhood Disintegrative Disorders
ASD DIAGNOSIS
• Based on observable behaviors
no medical test to diagnose autism or
related disorders
• Pattern of development
• Social, Communication, Behavioral Profile
• Developmental History Important
• Rule out other Disorders
Delays or abnormal functioning in at least
1 of the following areas, with onset prior to
age 3 years
*social interaction
*language as used in social communication
*symbolic or imaginative play
DSM-1V CRITERIA : AUTISTIC
DISORDER
• Qualitative impairment in reciprocal social
interaction(2)
.marked impairment in use of multiple non
verbal behaviors to regulate social
interactions
.failure to develop peer relationships
appropriate to developmental level
.a lack of spontaneous seeking to share
enjoyment, interests, or achievements with
other people
.lack of social or emotional reciprocity
Qualitative impairment in communication (1)
*delay in, or total lack of, the development of
spoken language
*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
*lack of varied, spontaneous make-believe play
or social initiative play appropriate to
developmental level
Restricted, repetitive, and stereotyped patterns of
behavior, interests and activities
*encompassing preoccupations h 1 or more
stereotyped and restricted patterns of interest that
is abnormal either in intensity or focus
*apparently inflexible adherence to specific, non
functional routines or rituals
*persistent preoccupation with parts of objects
DSM-1V CRITERIA: ASPERGER’S
DISORDER
*Qualitative impairment in reciprocal social interaction
*Restricted, repetitive, and stereotyped patterns of
behavior, interests, and activities
*There is no clinical significant general delay in language
.Single words by 2 yrs
.Communicative phrases by 3 yrs
*There is no clinically significant delay in cognitive
development
.Average or Above Average IQ score
DSM-1V CRITERIA: PDD-NOS
• Severe and pervasive impairment in
development of social interaction
• Impairment in either
.verbal or nonverbal communication skills
OR
.with the presence of stereotyped behavior,
interests, and activities
DIAGNOSING AUTISM
FIRST STEP
SCREENING
THEN
REFERRAL
FINALLY
EVALUATION AND DIAGNOSIS
EARLY DIAGNOSIS
LEADS TO
HIGH LEVELS OF
RECOVERY
SCREENING FOR ASD
*Child ideally younger than 3years
*Best done between ages 12mnths-24mnths
Done on 2 levels
Level 1
Primary caregiver reports
Numerous screening forms exist
CHAT
ESAT
CSBS
M-CHAT
Please fill out the following about how your child usually is.
Please try to answer every question. If the behavior is rare
(e.g..you’ve seen it once or twice),please answer as if the child
does not do it.
1. Does your child enjoy being swung, bounced on your knee,
etc.?
Yes No
2. Does your child take an interest in other children? Yes No
3. Does your child like climbing on things such as up stairs? Yes
No
4. Does your child enjoy playing peek-a boo/hide-and-seek?
Yes No
5. Does your child ever pretend, for example, to talk on the
phone or take care of a doll or pretend other things?
Yes No
6. Does your child ever use his/her index finger to point, to ask
for something? Yes No
M-CHAT (cont)
7. Does your child ever use his/her index finger to
point, to indicate interest in something?
Yes No
8. Can your child play properly with small toys (e.g.
cars or blocks) without just mouthing, fiddling, or
dropping them? Yes No
9. Does your child ever bring objects over to you
(parent) to show you something? Yes No
10. Does your child look you in the eye for more
than a second or two? Yes No
11. Does your child ever seem over sensitive to
noise? (e.g.. Plugging ears) Yes No
M-CHAT (CONT)
12. Does your child smile in response to your face
or your smile? Yes No
13. Does your child imitate you? (e.g..you make a
face-will your child imitate it?) Yes No
14. Does your child respond to his/her name
when you call? Yes No
15. If you point a toy across the room, does your
child look at it? Yes No
16. Does your child walk? Yes No
17. Does your child look at things you are looking
at? Yes No
18. Does your child make unusual finger
movements near his or her face? Yes No
M-CHAT (CONT.)
19. Does your child try to attract your
attention to his/her own activity? Yes No
20. Have you ever wondered if your child is
deaf? Yes No
21. Does your child understand what people
say?
Yes No
23. Does your child look at your face to check
your reaction when faced with something
unfamiliar? Yes No
• LEVEL 2
• PROFESSIONAL REPORTS
• FOCUSED ON BEHAVIOR
•
•
•
•
CSBC
PDDST
STAT
CARS (Childhood Autism Rating Scale)
• CARS most commonly used tool by professionals
COLLATION OF ALL INFORMATION
if suggestive
RERRERAL FOR
EVALUATION
WHO IS QUALIFIED TO MAKE AN ASD
DIAGNOSIS?
*Due to complexities in diagnosis relating to
range of behaviors various professionals
are needed.
* MULTIDISCIPLINARY TEAM
MULTIDISCIPLINARY TEAM
•
•
•
•
•
•
•
Special educators
General educators
Psychologists
Speech-language pathologists
Occupational therapists
Physical therapists
Physician(e.g., neurologist, pediatrician)
Multidisciplinary team should be
supervised by one of the following ;
*Licensed Clinical Psychologist
*Licensed Physician/Pediatrician
*School psychologist
DIAGNOSING ASDs
*Developmental history is important
*Rule out other disorders
DIAGNOSIS
Evaluation and
GOLD STANDARD ASSESMENTS
•
•
•
•
STATE-OF-THE-ART (Gold Standard
assessments)
EVALUATION FOR ASD
Medical examination
Parent interview (ADI-R)
Individual observation (ADOS by Professionals)
Developmental language testing
MEDICAL EXAMINATION
*Physical examination
*Rule out hearing / vision impairments
*Genetic Testing
*Neurological Examination
PARENT INTERVIEW ADI-R
*Developmental history
*Semi-structured interview about social skills
*Communication
*Behaviors and
*Adaptive skills
ADI-R (Physician administered)
Extensive Primary Caregiver Interview (93items)
* Early Development (7)
*Acquisition and Loss of Language/Other
Skills (20)
*Language and Communication
Functioning (21)
*Social Development and Play (10)
*Favorite Activities and Toys (7)
*Interests and Behaviors (13)
*General Behaviors (13)
AUTISM DIAGNOSTIC OBSERVATION SCHEDULE
(ADOS)
*Play/Interview-based assessment
*Five modules
.Toddler (12-30months)
.Preverbal/single words
.Phrase speech
.Fluent speech: Child/Adolescent
.Fluent speech: Adolescent/Adult
NOW THAT I HAVE A DIAGNOSIS…..
*Opportunity to educate physicians, teachers,
community providers about
.Diagnostic resources
.Early signs
.Referrals for intervention
*Be On Same Page
.Everyone in life
.Follow-up diagnosis?
*Start services and treatment
WHAT SERVICES SHOULD MY CHILD RECEIVE?
* Services should be based on
.3 main domains associated with ASD’S
- Social interactions
- Communication
- Behaviors and Interests
.Those specific challenges of ASD that face your child
- ASD is not a one-size-fits-all
- Should be tailored to those ASD criteria your
child meets
SERVICES SHOULD
*Promote independence and social responsibility
*Ameliorate behavioral difficulties
*Promote generalization across multiple
environments
*IFSP/IEP/ISP vehicle for planning and
implementing objectives and benchmarks
.Observables
.Moderate behaviors and skills
.Achievable within 1 year
.Expect to affect participation in
-Education
-Community
-Family life
SERVICES (CONT.)
*Social skills
.Imitate others
.Social initiations to others
.Response to adults AND peers
-Needs access to typical peers
.Parallel and interactive play with peers and siblings
*Communication
.Expressive verbal language
.Repetitive language
.Nonverbal communications skills
.Functional symbolic communication system
SERVICES SHOULD (CONT.)
*Increase engagement and flexibility in
developmentally appropriate activities and play
*Attend to the environment
*Respond to appropriate motivational system
*Motor skills
.Fine and gross
.Age appropriate functional activities
*Cognitive skills
.Symbolic play
.Basic concepts
.Academic skills
SERVICES SHOULD (CONT.)
*Replace problem behaviors
.More conventional and appropriate behaviors
*Increase independent organizational skills
.Success in general education classrooms
*Include parents and families as meaningful team
members – They are experts on their child
*Be consistent across settings
.Home, school, community.
CONCLUSIONS
• Diagnosis of ASD is a label that can get
services
• Label assists others to know what skills are
areas of strengths and which are areas of
needs
• No two individuals with ASD are alike
• Services should be tailored to individual’s
strengths and needs
THANK YOU
DR (MRS) E.A.E. ALUKO
MB BS FWACP, DAAP