Autism

Autism: A Complex Disorder

Opening VideosWhat does autism look like?http://www.youtube.com/watch?feature=player_detailpage&v=r788NSAQi9wWhat does autism feel like?http://www.youtube.com/watch?v=M20DIK1Yt3A&feature=youtube_gdata_player

What is Autism?Autism is a developmental disorder that appears in the first 3 years of life, and affects the brain's normal development of social and communication skills.mild to severe, about 10% have an extraordinary ability in one area, such as in mathematics, memory, music, or art. Such children are known as "autistic savants" (formerly known as "idiot savants."). co-morbid medical conditions which may include: allergies, asthma, epilepsy, digestive disorders, persistent viral infections, feeding disorders, sensory integration dysfunction, sleeping disorders, and more interferes with the ability to understand what is seen, heard, and touched

What is Autism?Autism Spectrum Disorder(ASD)-Many combinations of characteristicsWith or without MR or with or without epilepsySeveral disorders characterized by significant impairments of social & communication skills:Autistic Disorder, Aspergers Disorder, Pervasive Developmental Disorder (PDD), Retts Disorder, Childhood Disintegrative DisorderStereotypical patterns of interestBehaviors and onset is before 3

Core DeficitsProfound difficulty relating to others despite intelligenceLack of emotional and social reciprocityNot interested in shared playSmiling is limited 50% dont develop useful language and useful nonverbal gesturesEcholalia-parrot like repetition of wordsRepetitive behavior and interests-rocking, flapping, walking on tippy toesSelf-stimulatory behavior-rubbing something silky, staring into light, smelling certain thingsSensory or perceptual impairmentlimited verbal and nonverbal communication

Prevalence of Autism Spectrum Disorders in AmericaAccording to Center for Disease ControlIn 2000 &2002: 1 in 150In 2004: 1in 125In 2006:1 in 110In 2008: 1 in 88-Marks 78% increase in past decade

A new case is diagnosed every 20 minutesAutism is the fastest developmental disability in the country.5 times more prevalent in boys

*Site InformationCity**StudyAgesCountry****Number of Cases per 10,000 People***Year PublishedDiagnosis1 hospital at Sboos UniversityMuscatAl-Farsi Y.M. et al, 2010Up to 14 yearsOman1.42010ASD96 schools in Cidgshire CountyCambridgeBaron-Cohen S. et al., 20095 to 9 yearsUnited Kingdom942009ASD3 centers in HaifaHaifaDavidovitch M. et al., 20017 to 11 yearsIsrael102001Autistic Disorder3 departmentsToulouseFombonne E. et al., 19978 to 16 yearsFrance5.351997Autistic Disorder55 schools in MontrealMontrealFombonne E. et al., 20065 to 17 yearsCanada64.92006PDDDoctors, schoole Barwon regionSydneyIcasiano F., 20042 to 17 yearsAustralia39.22004PDDAll children in KarlstadKarlstadKadesjo B. et al., 19996 to 7 yearsSweden72.61999Autistic DisorderOne center In ToyotaToyotaKawamura Y., 20085 to 8 yearsJapan181.12008PDDTwo centers in entire countryReykjavikMagnusson P. et al., 20015 to 14 yearsIceland13.22001Autistic DisorderRandom samplingacross PortugalLisbonOliveira G et al., 20076 to 9 yearsPortugal16.72007Autistic DisorderWestern Australctrum DisordersPerthParner E.T. et al., 2011Up to 10 yearsAustralia512011ASDDanish Nationaliatric RegistryCopenhagenParner E.T. et al., 2011Up to 10 yearsDenmark68.52011ASDSchools and heabaia, Sao PauloSao PauloPaula C.S. et al., 20117 to 12 yearsBrazil27.22011PDDHistory of AutismTerm autism originally used by Bleuler (1911)To describe withdrawal from social relations into a rich fantasy life seen in individuals with schizophreniaDerived from the Greek autos (self) and ismos (condition)Leo Kanner 1943Observed 11 childrenInattention to outside world: extreme autistic alonenessSimilar patterns of behavior in 3 main areas:Abnormal language development and use Social skills deficits and excesses Insistence on sameness

History of Autism Continued Psychiatrist Hans Asperger (1944) - describes little professor syndrome Eisenberg and Kanner (1956)Added autism onset prior to age 2Further refined definition of autism Creak (1961)Developed 9 main characteristicsBelieved they described childhood schizophreniaIncorporated into many descriptions of autism and commonly used autism assessment instruments today

History of Autism Rutter (1968)Said the term autism led to confusion!Argued autism was different than schizophreniaHigher M:F ratioAbsence of delusions & hallucinationsStable course (not relapse/marked improvement)Further defined characteristics (for science, research) National Society for Autistic ChildrenOne of the 1st & most influential parent groups for children with autism in U.S.Wrote separate criteria (for public awareness, funding)Added disturbances in response to sensory stimuli & atypical developmentDid not include insistence on sameness

DiagnosisThere is no medical detection or cureRed flags:No babbling by 12 months.No gesturing (pointing, waving, etc.) by 12 months.No single words by 16 months.No two-word (spontaneous, not just echolalic) phrases by 24 months.Any loss of any language or social skills, at any ageAffects Learning Experience Severity of impairment in language engagement, social connectedness, sensory integration, and cognitive skills. Teacher awareness and understandingRigid in their thinking and behaviorsLack of social or emotional reciprocity in his or her classroom Sometimes feel sensory overload in environments-fan, light, dishes clanking Sensory issues in which the central nervous system craves input may also appear-fidget toy or exercise bandConditions That Look Like AutismLanguage delays, mild cognitive disabilities, attention deficit-hyperactivity disorder, disruptive behaviors and sleep disturbances

To be diagnosed with autism, a child must have deficits in three areas: communication, social skills and the ability to shift focus -- children tend to perform repetitive behaviors such as hand flapping

Cause and Controversy Genetics of autism are complex and unclearStudies of twins suggest heritability Rare mutations, or by rare combinations of common genetic variants Agents that cause birth defects Environmental causes, such as heavy metals, pesticides or childhood vaccines Vaccine hypotheses -lack convincing scientific evidenceMedication Antipsychotic medications : These medicines may help reduce aggression and other serious behavioral problems in children, including children with ASD. They may also help reduce repetitive behaviors, hyperactivity, and attention problems.Antidepressant medications, such as Prozac or Zoloft, are usually prescribed to treat depression and anxiety but are sometimes prescribed to reduce repetitive behaviors. Some antidepressants may also help control aggression and anxiety in children with ASD. Stimulant medications, such as Ritalin, are safe and effective in treating people with attention deficit hyperactivity disorder (ADHD). It has been shown to effectively treat hyperactivity in children with ASD as well.Warnings about MedicationFDA warning about antidepressantsAntidepressants are safe and popular, but some studies have suggested that they may have unintended effects on some people, especially in teens and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

A child with ASD may not respond in the same way to medications as typically developing children.

Treatments But No CureTreatments are aimed at reducing specific symptoms Goal- to lessen associated deficits and family distress, and to increase quality of life and functional independence.no single approach that works for all children training in music, listening, vision, speech and language, and sensesSpecial diets and medications: Stimulants-methylphenidate (Ritalin)Antidepressants - fluroxamine (Luvox)opiate blockers-naltrexone (ReVia)antipsychoticsEducational and behavioral treatments (ABA)speech therapyChildren with autismhttps://www.youtube.com/watch?v=riS53sCbLfohttps://www.youtube.com/watch?v=3yTvaqw9M8g

TreatmentsEvery child has the right to a free appropriate education. The Individuals with Disabilities Education Act (IDEA), ratified in 1975, allows a public education for all eligible children and makes the schools responsible for providing the supports and services that will allow this to happen.Examples of these treatments are Speech & Language Therapy, Occupational Therapy, or the care of a Neurologist or Gastroenterologist.Occupational Therapy or Speech & Language Therapy are often integrated into one of the intensive therapy programs described here as core symptom therapiesServicesStarting as soon as a child has been diagnosed with ASDProviding focused and challenging learning activities at the proper developmental level for the child for at least 25 hours per week and 12 months per yearHaving small classes to allow each child to have one-on-one time with the therapist or teacher and small group learning activitiesHaving special training for parents and familyMeasuring and recording each child's progress and adjusting the intervention program as needed

Services continued Using a curriculum that focuses on Language and communicationSocial skills, such as joint attention (looking at other people to draw attention to something interesting and share in experiencing it)Self-help and daily living skills, such as dressing and groomingTEACCH (Treatment and Education of Autistic and related Communication handicapped Children)emphasizes adapting the child's physical environment

Medical CostAutism society estimates that the lifetime cost of caring for a child with autism ranges from $3.5 to $5 million.Research, insurance cost. Medicaid waivers, educational spending, housing, transportation, therapeutic services and caregiver costs - $90 billion annuallyApproximately $17,000 per year per childMore severe ASD - $21,000 per year per childOn the average medical expenditures for those with ASD were 4.1-6.2 times greater than those without ASDIntensive behavior interventions cost $40,000 to $60,000 per year per child

Legal Rights InformationIndividuals with Disabilities Education Improvement Act or IDEA-law mandates that the state provide all eligible children with afree and appropriatepublic education that meets their unique individual needs.Children with autism are entitled to early intervention services and special education. If your child has been diagnosed with a form of autism, the diagnosis is generally sufficient to gain access to the rights afforded by IDEA.Your child is also entitled to experience the least restrictive environment.The school district is not required to provide the best or optimal but rather afree and appropriate education.Appropriate is the one that relates specifically to your special needs

MythsPeople with autism dont want friendsPeople with autism cant feel or express any emotion happy or sadPeople with autism cant understand the emotions of othersPeople with autism are intellectually disabledPeople with autism are just like Dustin Hoffmans character in Rain ManPeople who display qualities that may be typical of a person with autism are just odd and will grow out of itAutism is just a brain disorderAutism is caused by bad parentingThe prevalence of autism has been steadily increasing for the last 40 yearsTherapies for people with autism are covered by insuranceGood NewsNegative behaviors of autism may improve Earlier generations placed autistic children in institutions Disabled children can be helped in a less restrictive environment to develop to their highest potential Can handle a job; they do best with structured jobs that involve a degree of repetition.Autistics can lead a normal life with help

Tips for teaching kids with autismApplied Behavior Analysis (ABA)The goals of ABA are to shape and reinforce new behaviors, such as learning to speak and play, and reduce undesirable ones. ABA, which can involve intensive, one-on-one child-teacher interaction for up to 40 hours a week, has inspired the development of other, similar interventions that aim to help those with ASD reach their full potential.

APPLIED BEHAVIORAL ANALYSISABA is the use of scientific principles of learning and motivation to teach effectivelyThe core concept is that the consequences of what we do affect what we learn and what we will do in the futurePositive reinforcement: behaviors that produce a good outcome are more likely to occur in the futurePeople are motivated by what they get out of what they doExamples: money, feeling good for helping someone, approval from others, satisfaction of a good book, etc.

POSITIVE REINFORCEMENT

The ABA approach to autism is to identify what motivates each individual childEvery child is differentTeaching must use what is motivating to the child, not what we think should be motivating to the childThen we teach the child by teaching new skills in very small steps and rewarding the child with positive reinforcement when they make an effort at learning

ACCOUNTABILITY & EFFECTIVENESSABA assumes that if a child is not learning, it is NOT the childs fault, it is our faultWe must change the way we are teachingWe must continue to try different ways of teaching until we find one that worksABA is the best method for finding what worksWe never blame the child if learning does not happenWe believe its our responsibility to figure out how to teach whatever the child needs to learn

CHALLENGING BEHAVIOR

Examples: aggression, self-injury, self-stimulatory behavior, tantrumsABA assumes that children are getting something they want from challenging behaviorAttentionEscapeToys or foodSensory stimulationAutism is NOT the cause of bad behavior

Case studyHelpAutism Speaks, the world's leading autism science and advocacy organization www.autismspeaks.org offers a safe and fun event for families impacted by autismNational Autism Association - parent-run advocacy org. ww.nationalautismassociation.org

Lets Discuss AutismThe growth of autism has been dramatic, unexpected and still largely unexplained. Some wonder whether the new numbers stem from too broad a definition of autism or do we have national emergency?What do you think is the cause of autism? Is it environmental, more biological or both?Until the cause of autism is discovered, prevention is not possible. Do you believe this? Are their steps we can take to prevent autism?Who should care for autistic individuals? What can you do to raise their quality of life? ReferencesCenters for Disease Control and Prevention. (June, 2013). Data & Statistics. Retrieved from http://www.cdc.gov/ncbddd/autism/data.htmlFriedlander, D. (2009). Sam comes to school: Including students with autism in your classroom. The Clearing House, 82(3), 141-144. Retrieved from http://search.proquest.com/docview/196845141?accountid=7286Hrdlicka, M., & Dudova, I. (2013). Controversies in autism: Is a broader model of social disorders needed?. Child And Adolescent Psychiatry And Mental Health, 7doi:10.1186/1753-2000-7-9

ReferencesAutism Spectrum Disorder. (2013). NIMH RSS. Retrieved March 20, 2014, http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-pervasive-developmental disorders/index.shtml?utm_source=rss_readers&utm_medium=rss&utm_campaign=rss_full#part6Rudavsky, S. (2012, Mar 30). 1 in 88: Children with autism. Indianapolis Star. Retrieved from http://search.proquest.com/docview/963937737?accountid=7286Turkington, C. A. (2002). Autism. In D. S. Blanchfield & J. L. Longe (Eds.), The Gale Encyclopedia of Medicine (2nd ed., Vol. 1, pp. 417-421). Detroit: Gale. Retrieved from http://go.galegroup.com.ez-proxy.brooklyn.cuny.edu:2048/ps/i.do?id=GALE%7CCX3405600196&v=2.1&u=cuny_broo39667&it=r&p=GVRL&sw=wMedical costs http://www.autism-society.org/get-involved/the-budget-crisis.html, http://www.cdc.gov/ncbddd/autism/data.htmlMyths https://www.dosomething.org/tipsandtools/11-myths-about-autism