Autism 101 Glenwood, Inc. 2013

Transcription

1 Autism 101 Glenwood, Inc. 2013

2 DSM-5

3 CURRENT DX CRITERIA Although ASD s are neurological, there are no current medical tests to use for a diagnosis. We currently use behavioral symptoms to make a diagnosis, as determined by the DSM-5. However, no two individuals with an ASD will present in the same manner.

4 DSM-5 Pervasive Developmental Disorders: No longer the clinical term The 5 sub-types of PDD are no longer clinical diagnoses per the DSM-5

5 Previous DX Categories: DSM-IV TR Image source:

6 DSM-5 Criteria The diagnostic criteria for Autism Spectrum Disorder were published in May

7 Proposed Criteria- Part A Currently or by history, must meet criteria from A, B, C, and D below: A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction, 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and bodylanguage, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people

8 So What Does This Look Like? Running into a peer to get attention Failure to show recognition that someone is there Sudden approach with a factual monologue Walking by someone who has just been injured with no emotional reaction Comments completely unrelated to what has just been said Failure to respond at all

9 DSMV Part A Flat affect Failure to realize that the teacher is addressing the individual when speaking to the group Difficulty following a point or other gesture Difficulty interpreting others facial expressions Solitary or parallel play when others are interacting Focus on object or activity rather than socializing May have more interest and success interacting with younger children or adults

10 DSMV Part A Failing to notice peer pressure, trends Talking at, reporting, with lack of awareness of others interests or reactions Misinterpretation of social cues (friendly teasing, instrumental versus reciprocal relationships, stealth bully victimization, attributing malicious intent to accidents)

11 Language Delay? It is implied that lack of verbal communication leads to lack of social communication. Verbal speech delay is not required for ASD diagnosis but is very common, even in children who previously met criteria for Asperger s Disorder.

12 Proposed Criteria- Part B B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

13 So What Does Part B Look Little Professor Like? Borrowed Speech Echolalia with no evidence of comprehension Very noticeable motor mannerisms Subtle but repetitive motor mannerisms (hand-picking, slightly odd gait) Engaging in perseverative actions with objects

14 DSMV Part B Self-imposed, unnecessary routines Difficulty transitioning from current activity Resisting change to normal routine Repetitive speech and questioning Fixation on topic, person, event, object Special interest may be appropriate for age and gender, but abnormal in INTENSITY

15 DSMV Part B- SENSORY!!! Abnormal processing causing sensory hypo- or hyper-sensitivity (nociceptive nerve stimulation versus perceptive-interpretation by brain) This is highly individualized, and both hypo- and hyper-sensitivity may be present in the same individual This is due to neurological processing and is not merely a preference. This degree of abnormal processing interferes with the individual s daily functioning

16 Sensory Integration Dysfunction: What it may look like Vestibular System dysfunction thrill seeker (increase tolerance movement) lethargic hypotonia Proprioceptive System dysfunction clumsy lack of awareness of body in space odd body posturing Tactile System dysfunction withdraw when cuddled sensory seeking textured food clothing won t get hands dirty unaware of touch biting self tactile defensiveness Visual, Auditory and Olfactory look out of corner of eye sensitive to light balance hyper or hypo responsive to sound

17 DSMV Parts C&D C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) D. Symptoms together limit and impair everyday functioning.

18 Severity of the ASD with DSM-V Level 3- Requiring Very Substantial Support Level 2- Requiring Substantial Support Level 1- Requiring Support

19 Note: Social (Pragmatic) Communication Disorder Social Communication Disorder is a new diagnostic category; ASD must first be ruled out! Similar social, pragmatic language deficits as with ASD, but without the stereotyped, repetitive, and restricted behaviors. Some individuals formerly diagnosed with PDD-NOS may fit into this category

20 VIDEOS

21 ASSOCIATED FEATURES Associated features are characteristics commonly seen in children diagnosed with Autism Spectrum disorders. However, existence of these behaviors does NOT equal an Autism Spectrum diagnosis. In other words, they are not defining symptoms. Disturbed sleep patterns Hyperactivity and Impulsivity Difficulty understanding the environment Other (e.g., slow to shift attention, literal thinking, clumsy)

22 ASSOCIATED FEATURES Literal thinking Go jump in the lake Raining cats and dogs You may have to sit here forever Go flip off the projector.

23 Theory of Mind/Perspective Taking Many individuals on the Spectrum do not understand that other people have their own plans, thoughts, and points of view. Have difficulty understanding other people s beliefs, attitudes, and emotions. Seems to be independent of intelligence.

24 Theory of Mind/Perspective Taking: Presenting Problems Problems relating socially. Communicating with other people. May have difficulty understanding that their peers or classmates have thoughts and emotions and may appear: self-centered, eccentric, or uncaring.

25 MYTH BUSTERS Autism is not a mental illness. Autism is not the result of poor parenting. Children with autism are not unruly or spoiled kids who just have a behavior problem.

26 MYTH BUSTERS Children with autism are not without feelings and emotions. Children and adults with autism spectrum disorders care about others but lack the ability to spontaneously develop empathetic and socially connected behavior.

27 MYTH BUSTERS No known psychological factors in the development of the child have been shown to cause autism.

28 SIMILAR BUT DIFFERENT People with ASD differ greatly. They are individuals with unique personalities. No two people with ASD will have the same symptoms. Spectrum Disorders are defined by a certain set of behaviors. There is no standard type or typical person with an ASD. Symptoms will range from mild to severe across individuals.

29 PREVALENCE OF ASD S Occurs 4 times more in males than females. Occurs across all ethnic, racial, social boundaries, SES and educational levels. 1 in 88 (CDC, 2012); rate in boys is 1 in 54, rate in girls 1 in 252. Diagnosis at age 2 is reliable and valid, but most children are diagnosed after age 4 ASD s grew 78% from 2002 to 2008 Estimated to reach 4-million Americans in the next decade.

30 Prevalence of ASD s Males vs. Females 4.5 to 1 Current estimates 38% with co-morbid Intellectual Disability 13% to 29% experienced regression of skills 83% have at least one other developmental diagnosis; at least 10% have a co-morbid psychiatric diagnosis Prevalence increased among all SES/Ethnic groups

31 CO-MORBID CONDITIONS Depression and Anxiety Disorders Bowel Disease Fragile X Syndrome Hyperactivity and Attention Abnormalities Obsessive-Compulsive Disorder Seizures Tuberous sclerosis-(tumors within the body organs)

32 Prevalence of Autism Spectrum Disorders Growth comparison during the 1990s: U.S. population increase: 13% Disabilities increase: 16% Autism increase: 172% Percentage Increase (1990's) US Population Disabilities ASDs 1 2 3

33 PREVALENCE OF ASD S $90 billion annual cost. 90% of costs are in adult services. Cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention. In 10 years, the annual cost will be $ billion. Overall incidence of autism is consistent world-wide.

34 Prevalence Prevalence is increasing why? Better understanding? Better identification/diagnosis? Better early identification (18 months old)? More cases? Increasing popularity?

35 ETIOLOGY/CAUSES NO KNOWN SINGLE CAUSE FOR AUTISM. Complex Developmental Disability that typically appears during the first 3- years of life. Result of a neurological disorder that affects the normal functioning of the brain (Autism Society of America).

36 ETIOLOGY/CAUSES Theories related to: Genetics Identical twin- other twin up to 95% likely to also receive DX; fraternal twin- other twin up to 31% likely to also receive DX Environment No one gene has been identified as causing Autism. No one environmental agent has been identified as causing Autism. Generally accepted that it is caused by abnormalities in brain structures and/or function.

37 Etiology/Causes Multiple explanations due to the complexity of Spectrum of Disorders: Genetic (e.g., likely involvement of several genes [2-5] in different combinations). Prenatal/Perinatal insults (e.g. infections Rubella)

38 Etiology/Causes Cerebellum Connected to systems regulating attention, sensory modulation, and motor and behavior initiation Limbic System Social skills deficits Neurological Dysfunction (e.g., low levels of Serotonin) Research Evidence Anecdotal reports of contributing factors (MMR, allergies)

39 Common Elements in Effective Autism Treatment (Dawson & Osterling, 1997) Five basic skill domains attention, imitation, language use and comprehension, appropriate play skills, and social interaction skills Supportive teaching environments and generalization strategies

40 Common Elements in Effective Autism Treatment (Dawson & Osterling, 1997) Predictability and routines (Structured Teaching) Functional approach to problem behaviors Identify function of behavior (Applied Behavior Analysis) Teach alternative behaviors to serve the same function Transition planning (Vocational) Family Involvement and Continuity Across Settings (Generalization Strategies)

41 Questions??