Autism and other developmental disorders. Dr. Martin Maldonado

Transcription

1 Autism and other developmental disorders Dr. Martin Maldonado

2 Autistic Spectrum Autistic Disorder Autistic Psychopathy Childhood psychoses (Europe and Latin America) Multi-system developmental disorder (Greenspan) Others (ctd)

3 Autistic Spectrum Pervasive developmental disorders Multiplex disorder Asperger s disorder Rett Syndrome (girls) Disintegrative disorder ( or dementia)

4 Autistic Spectrum A syndrome rather than one disorder Different degrees of manifestations: a continuum of severity Core symptoms or groups of phenomena Different causes or unknown cause

5 Autistic disorder A quite reliable diagnosis in child psychiatry ( also Rett and Disintegrative) More difficulty with Asperger and pervasive developmental disorder

6 Autistic core symptoms 3 groups DIFFICULTY IN RECIPROCAL RELATEDNESS (Disorders of empathy?) (Gillberg) DIFFICULTY IN LANGUAGE FOR COMMUNICATIVE PURPOSES DIFFICULTY IN DEVELOPMENT OF IMAGINATION ( Range of interest)

7 Multisystem dev. Disorder Zero to Three conceptualization (Greenspan) Three Patterns, A, B, C A continuum of difficulties, depending on self-absorption, relatedness, use of language Conceptualization as within development, so child can improve

8 Pattern A of MDD Most difficulty Relatedness. Almost no relationship. Not interested Only one sensory channel, little responsiveness in others Lacks interpersonal warmth and pleasure in relationships Inappropriate or non/modulated affect

9 Pattern A of MDD Very few intentional gestures, if any Perhaps only denotes physiological needs, e.g. eating No expressive language No symbolic play Not much interest in surroundings

10 Pattern B of MDD Intermittently relational vis a vis others Marked difficulties in motor planning More challenge in gestural communication Brief periods of engagement Affect. Accessible but fleeting no deep interpersonal joy

11 Multisystem. Pattern B. continued Enjoy repetitive and perseverative activities with objects ( not only self stimulation) Tend to over-focus on objects to modulate sensory and interpersonal input Intermittent use intentional gestures

12 Multisystem pattern B. ctd More organized in seeking sensation Running, jumping, wanting tactile and other input more developed visual and spatial skills Difficulty with changes and transitions but can adapt to routines

13 Multisystem Pattern C In and out style of relating to others child is in control, starting and ending interactions Easier to woe the child into interaction Tends to hide, etc. but eye contact if safe Better sense of intentionality

14 Multisystem Pattern C. ctd. Islands of real interpersonal plesure Avoidance and aloofness at other times Spontaneous interactions Reacts to routine communications Language. Simple gestures and some complex intentional communications, mostly around his/her needs

15 Mulisystem Pattern C ctd More ability to recite things and learn by rote Some words if pressured Simple symbolic play, or stereotyped Motor planning difficulties, gets overexcited Most adaptive and organized

16 Autistic spectrum Common sensory processing peculiarities Eg. Hyper-sensitive to visual, auditory, tactile, vestibular stimulation Proprioception? Motor panning? Equilibrium and balance? Insistence on sameness and routine

17 Autistic spectrum Increased frequency recently? Typical: 4 in children PDD and others in children More common in boys High heritability of autism (50 times more frequent in siblings), but a rare disorder

18 Autistic spectrum. Some etiologies Genetic loading. Pedigree Congenital rubella Dysmorphic syndromes ( West syndrome). Neurological conditions. Tuberous sclerosis, etc. Other possibilities

19 Pathophysiology Difficulty in mind reading Difficulty in face processing Obtaining mentalistic significance from gestures Difficulty in management of language. E.g. pragmatics, sarcasm, pretence. Difficulty in empathy

20 Pathophysiology Cortex. Layering and distribution of cells. Migration of cells Vermis in cerebellum. Lobes 5 and 6 Diminished number of brain cells? Asymmetry between lobules. Predominance of right brain functioning?

21 Diagnosis History and clinical evidence Direct observation of child in natural settings and different environments Elicitation of language function, symbolization, and relatedness Understanding of others and mind reading Interest in faces and eyes

22 Diagnosis Sensory integration problems are not specific, but occur in many other disorders Commonly feeding difficulties Commonly sleeping difficulties Commonly attentional problems, hyperactivity, perhaps aggression

23 Autistic spectrum Main problem is of deviation in development Many children also exhibit delay in development Central feature is deviation of development

24 Language Absence of language or Language used not for communicative purposes Dysphasic features. Intonation, semantic issues, pragmatic issues ( use of language in context)

25 Autistic spectrum Commonly attentional and hyperactivity problems Complication with seizure disorder Deterioration in IQ Need for early intervention and diagnosis Pointing, reciprocal attention, mutual gaze,

26 With the child With the family Interventions With other relatives and support persons With schools and other settings

27 Interventions Relational training combination of wooing the child with respect and need for distance Reciprocal games Mind reading games Mind reading activities and scenarios

28 Interventions. Multimodal Social abilities Turn taking Reading facial expressions Monitoring others Understanding faces, etc.

29 Interventions Sensory integration treatments Look for preferred sensory channel Look for sensory diet and signs of overload or tolerance Look for soothing activities: e.g. deep pressure, massage, breaks in stimulation, vestibular stimuli, etc.

30 Interventions Behavioral therapy. Special education Pharmacotherapy Language Therapy Day Hospital and school approaches Medications for specific purposes, e.g. psychostimulants, for aggression, for sleep, etc.