AUTISM SPECTRUM DISORDER

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1 AUTISM SPECTRUM DISORDER Targeting Autism National Forum March 4, 2015 Springfield, IL Russell J. Bonanno, M.Ed. 1 AGENDA What is ASD (definition, causes) Diagnostic Criteria (DSM-5) Getting a Diagnosis Differential Diagnosis & Comorbidity Interventions Resources Q & A 2 1

2 HOW MANY PEOPLE HAVE ASD? CDC (2013) says 1 in 68, although rates varied widely across states Parent survey by CDC (2014) says 1 in 50 Population survey (Korea, 2013) says 1 in 36 New numbers expected late March 3 WHAT IS AUTISM SPECTRUM DISORDER? Neurodevelopmental Disorder Early onset, probably in utero Genetic and Environmental Components In majority of cases, cause not known Spectrum Disorder Possibly multiple conditions Presentation varies greatly Response to treatment varies greatly 4 2

3 NEURODEVELOPMENTAL DISORDERS (DSM-5) Manifest early in development, usually before grade school. Frequently co-occur Involve symptoms of excess and deficit Includes: Autism spectrum disorder Intellectual disability Attention Deficit Hyperactive Disorder Communication disorders Specific learning disorders Neurodevelopmental motor disorders 5 GENETIC FACTORS Research shows high level of heritability (37% - 90%) About 15% due to identified genetic mutation Possible multiple genetic risks More prevalent in males than females 6 3

4 ENVIRONMENTAL FACTORS Generally speaking, environmental factors in this case mean in utero or prenatal. Advanced parental age? Low birth weight? Low folate during pregnancy? Air pollution? 7 WHAT DOESN T CAUSE AUTISM? Bad parenting Vaccines 8 4

5 LET S MEET BRANDON 9 SPECTRUM DISORDER Level of impact and function varies greatly Level of support needed varies Various concurrent/comorbid conditions Symptom cluster could reflect different conditions or disorders Varied response to interventions, medications, etc. 10 5

6 DIAGNOSTIC CRITERIA ALL NEEDED A. Persistent deficits in social communication and social interaction across multiple contexts B. Restricted, repetitive patterns of behavior, interests, or activities C. Symptoms must be present in early developmental period D. Symptoms cause clinically significant impairment E. Not better explained by ID or GDD. 11 WHAT DO WE SEE? SOCIAL/COMMUNICATION Difficult or lack of eye contact Not recognizing social norms, cues Difficulty interpreting nonverbal cues Lack of vocal inflection, rhythm Precision with words, literal interpretations From non-verbal to highly verbal No conversational dance 12 6

7 A CONCRETE CONVERSATION 13 WHAT DO WE SEE? RESTRICTED, REPETITIVE Stereotyped/repetitive movements, stimming, echolalia, flipping objects Inflexible routines, ritualized patterns Restricted interests Unusual sensory interests and/or response 14 7

8 DIAGNOSTIC PROCESS Generally starts with screening. AAP and CDC recommend regular formal screening at well child visits. M-CHAT, CARS, others Screening has false positives should be followed with observational screening Experience in diagnosis, especially developmental issues needed. ADOS and ADI-R diagnostic tools 15 DX WHAT DO WE KNOW? Parents express concern often when children are months ADOS-2 can indicate ASD at 24 months or earlier Average age of DX in US is about 4 years Multi-disciplinary teams not always needed for DX, but often advantageous for treatment planning 16 8

9 DX WHAT DO WE KNOW? (2) Often many other diagnoses before ASD ASD does not rule out co-morbid ID, ADHD, Anxiety Disorders, etc. Possibility that some of difference in male/female diagnostic rates are social, or females have more subtle presentation Genetic testing may be helpful in some cases to identify co-morbid issues like Fragile-X 17 COMORBID CONDITIONS About 70% have one cormorbid DSM condition About 40% may have two or more cormorbid DSM conditions There can be concurrent ADHD Developmental coordination disorder Anxiety disorders Depressive disorders Many other conditions! 18 9

10 INTERVENTIONS Early intensive behavioral intervention (EIBI) shown to have greatest positive results ABA and ABA-related interventions Social skills Specific skills training (OT, vocational training, etc.) 19 INTERVENTIONS WITH CHILD Behavioral interventions most successful Early focus on communication (expressive and receptive) multiple methods (PECS, ASL, AAC) Individual and small group interventions Consistency across environments needed for best results 20 10

11

12 23 INTERVENTIONS WITH FAMILY In all BH therapy, need to enlist parents when working with child Especially need to teach parents to continue structure outside of office Major stress on all members of family Don t overlook siblings Traditional family therapy to address stress, communication, relationships 24 12

13 ROLE OF MEDICATION Primary intervention is behavioral Medication seen as augmenting behavioral intervention or making client more amenable to interventions Most medication use in ASD is off label Dosages often quite different from label use. Experience in ASD imperative. 25 CASE MANAGEMENT / WRAP The client exists in multiple environments Clients with ASD respond best with consistency, no surprises Coordination with school, other agencies gives greatest success 26 13

14 ADDITIONAL RESOURCES CONTACT INFORMATION Russell J. Bonanno, M.Ed

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