Autism Spectrum Disorder What is it? Robin K. Blitz, MD Director, Developmental Pediatrics Resident Autism Diagnostic Clinic Lecture Series #1
Learning Objectives What can we talk about in 20 minutes? What is Autism? What are the Autism Spectrum Disorders? And a few Autism-isms
What is Autism? Autism is a complex neurobiological disorder Onset before 3 years of age Lifelong disability DSM-IV Diagnostic Criteria: Qualitative impairment in social interaction Qualitative impairments in communication Restrictive repetitive & stereotyped patterns of behavior, interests, & activities Symptoms not better accounted for by Rett s Disorder or Childhood Disintegrative Disorder
Qualitative Impairment in Social Interaction 2 or more of the following: Impairment in use of multiple nonverbal behaviors Eye-to-eye gaze, facial expression, body posture, gestures Failure to develop peer relationships Appropriate to developmental level Lack of spontaneous seeking to share enjoyment, interests, achievements Lack of showing, bringing, pointing Lack of social reciprocity
Qualitative Impairments in Communication 1 or more of the following: Delay in, or lack of development of spoken language Uncompensated by alternate modes of communication Impairment in ability to initiate or sustain a conversation In individuals with adequate speech Stereotyped & repetitive use of language Idiosyncratic language Lack of varied, spontaneous play Make-believe or social imitative play, appropriate for developmental age
Restricted, Repetitive & Stereotyped Patterns of Behavior, Interests & Activities -1 or more of the following Encompassing preoccupation with one or more stereotyped & restricted patterns of interest Abnormal in intensity or focus Inflexible adherence to specific, nonfunctional routines or rituals Stereotyped & repetitive motor mannerisms Hand or finger flapping, twisting, or complex, whole-body movements Persistent preoccupation with parts of objects
Asperger Disorder A. Qualitative impairment in social interaction, as manifested by at least 2 of the following: marked impairment in the use of multiple nonverbal behaviors such as eye-to eye gaze, facial expression, body postures, and gestures to regulate social interaction failure to develop peer relationships appropriate to developmental level lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) lack of social or emotional reciprocity B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least 1 of the following: encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity of focus apparently inflexible adherence to specific, nonfunctional routines or rituals stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) persistent preoccupation with parts of objects C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
AUTISM - ISM What did you write your essay on?
DSM-IV (1994) DSM-IV-TR (2000) Pervasive Developmental Disorders: Autistic Disorder Asperger Disorder PDD- NOS Rett s Disorder Childhood Disintegrative Disorder
DSM-V - new classifications May 2013 Rett Disorder will no longer be a DSM diagnosis To be subsumed under Autism Spectrum Disorder or Autistic Disorder: Autism PDD-NOS Asperger Disorder Childhood Disintegrative Disorder
DSM-V criteria for ASD Clinically significant, persistent deficits in social communication and interactions, as manifest by all of the following: Marked deficits in nonverbal and verbal communication used for social interaction Lack of social reciprocity Failure to develop and maintain peer relationships appropriate to developmental level Restricted, repetitive patterns of behavior, interests, and activities, as manifested by at least 2 of the following: Stereotyped or repetitive speech, motor movements or use of objects Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change Highly restricted, fixated interest that are abnormal in intensity or focus Hyper- or Hypo- reactivity to sensory input or unusual interest in sensory aspects of environment Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
Restricted, Repetitive Patterns of Behavior, Interests or Activities -At least 2 of the following: Stereotyped or repetitive speech, motor movements or use of objects Echolalia Hand flapping, Spinning, Toe-walking Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change Motoric rituals, insistence on same route or food, repetitive questioning, extreme distress at small changes Highly restricted, fixated interests that are abnormal in intensity or focus Restricted interests with a specific toy (or part of a toy), hobby, or topic Hyper or hypo- reactivity to sensory input or unusual interest in sensory aspects of environment Hypersensitive to loud noises, hair-washing, nail-cutting, tags, bright lights, food textures, chaotic environments, smells Sensory-seeking- licking, jumping, deep pressure
Autism and co-occuring conditions Developmental dx = 83% ADHD, language dis, LD, Intellectual disability, NVLD, SPD Psychiatric dx = 10% Anxiety, CD, ODD, BPD, depression, emotional dis, mood dis, mutism, OCD, psychosis, RAD, schizophrenia Neurologic dx = 16% Encephalopathy, CP, Sz / epilepsy, brain injury, vision or hearing loss, tics or Tourette s Causative genetic / neuro dx = 4% TS, Fra X, DS, birth defects, other genetic or chrom. dis
AUTISM-ISM The Wrong Shoes