Autism Childhood Autism and Dr. K. A. Korb University of Jos Autism comes from the Latin within oneself Autism: Severe developmental disorder characterized by abnormalities in: Social functioning Language and communication Unusual interests and behaviors Autism is a biologically-based, lifelong disability that is present in the first few years of life Behavioral Characteristics of Autism Disregards people for objects Avoids eye contact Lacks social awareness Limited language skills Repetitive motor activities Anxious and obsessive insistence on same daily routines and activities Extreme fear or avoidance of noisy or moving objects Attracted to and preoccupied with an object or activity Autism, Part 1 A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3) (1)Qualitative impairment in social interaction, as manifested by at least two of the following: (a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction (b) failure to develop peer relationships appropriate to develop level (c) a lack of spontaneous seeking to share enjoyment, interests, or achievement with other people (e.g. by lack of showing, bringing, or pointing out objects of interest) 1
Autism, Part 2 (2) Qualitative impairment in communication as manifested by at least one of the following: (a) delay in, or total of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) (b) in individual with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others. (c) stereotyped and repetitive use of language or idiosyncratic language. (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level. Autism, Part 3 (3) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following (a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focused (b) apparently inflexible adherence to specific, nonfunctional routines or ritual (c) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex wholebody movement) (d) persistent preoccupation with part of objects. Autism Autism is a spectrum disorder, meaning that symptoms and abilities are expressed in a wide range of degree of severity Children with autism vary in their: Level of intelligence Severity of language problems Ability to develop Social Impairments Children with autism have difficulty understanding and responding to social information Difficulty understanding emotional information in body language, gestures, facial expressions, or voice Have mechanical face expressions but limited use of expressive gestures 2
Communication Impairments Autistic children do not use expressive gestures to convey feelings (e.g., sadness or embarrassment) About half of children with autism never develop useful language skills Children with autism who do develop language generally: Lack social chatter (e.g., greeting) Repeat exactly what was said to them Use language literally Autism and Talents About 25% of children with autism have a special intellectual skill that is above average for the general population (e.g., spelling, reading, arithmetic, music, or drawing) Autistic savants:children with autism who have extraordinary talents (e.g., calculation, memory, music, or drawing) About 5% of children with autism are savants These skills are rarely helpful for daily living Course of Autism Most parents notice symptoms of autism by 2 years of age Most children show a gradual improvement with age, but still experience serious difficulties About 70% of children with autism show poor outcomes with limited progress and continuing handicaps that prevent them from being independent from others care Treatment for Autism The goals of treatments for autism are to maximize the child s ability to care for themselves and help the child and family cope more effectively with the disorder Treatment depends on the severity of symptoms, degree of language impairments, and level of intellectual functioning Goals for low-functioning children: Eliminate harmful behavior and teach self-help skills, communication of needs, and obedience to simple rules Goals for high-functioning children: Teach language fluency and appropriate social interaction Early intervention has found to have the best effects on functioning 3
Overview Treatments of Autism Childhood-Onset Initial stages of treatment Build rapport with the child Teach learning readiness skills Reduce or eliminating disruptive behavior Teaching Appropriate Social Behavior Teach imitation and observational learning Express affection Social play and social skills Teaching Communication Skills Operant speech training Verbal imitation Receptive labeling Expressive labeling Incidental teaching Sign language training Family Intervention Behavioral parent training Parent counseling Educational Interventions : Disorder of the brain expressed in abnormal mental functions and disturbed behavior Severe psychotic symptoms: bizarre delusions, hallucinations, thought disturbances, significant impairment in functioning, motor dysfunction ranging from wild agitation to immobility, and extremely inappropriate or flat affect Childhood-onset schizophrenia is the same, but more severe form of adult-onset schizophrenia Distinction between Autism and Childhood-Onset has: Later onset of problem behaviors Less intellectual impairment Less social and language deficits Hallucinations and delusions Periods of remission and relapse General Progression of 1. Difficulty concentrating, sleeping, and doing school work. Avoids friends. 2. Speak incoherently. See or hear things nobody else does. 3. Rotate between disordered thinking and improvement 4. Experience hallucinations, paranoia, and delusions 4
At least two or more of the following symptoms are present for a significant portion of time during a 1-month period: (1)Delusions (2) Hallucinations (3)Disorganized speech (e.g. frequent derailment or incoherence) (4) Grossly disorganized or catatonic behavior (5)Negative symptoms-that is, affective flattening, alogia*, or avolition** If delusion are bizarre or if hallucinations consist of a running commentary about the person or two or more conversing voices, then only of these symptoms is required to make the diagnosis. Psychotic Symptoms Delusions: Disturbances in thinking Disordered thought content and strong beliefs that are misrepresentations of reality Hallucinations: Disturbances in perceptions Things that are seen, heard, or sensed though they are not real or present The most common symptom in childhood-onset schizophrenia is auditory hallucinations (80%) 40-60% experience visual hallucinations and delusions *Alogia: Lack of speech **Avolition: Lack of drive, or motivation to pursue meaningful goals Treatment for Antipsychotic drugs are helpful for improving the functioning of people living with schizophrenia Psychosocial treatment should also be included for social skills training and family interventions 5