Autism Spectrum Disorders: An Introduction
Rhea Paul, Ph.D., CCC-SLPSouthern Connecticut State University
Yale Child Study CenterFeb. 11-15, 2008
Another Way to Look at it
Autistic Disorder
Impairment in social interaction-at least 2 of: Gaze, facial expression, gesture impairments Failure to develop peer relationships Lack of seeking to share with others Lack of reciprocity
Impairment in communication-at least 1 of: Delay in language Impairment in conversation ability Stereotyped and repetitive langauge Lack of pretend play
Restricted, repetitive stereotyped behavior, interests, activities-at least 2 of: Preoccupations with abnormal focus or intensity Rigid need for routine or ritual Motor mannerisms Preoccupation with parts of objects
Onset before age 3
Autistic Disorder- 3 Examples http://
www.youtube.com/watch?v=kSB_BQgOEx0&feature=related
Asperger Syndrome in DSM-IV
Impairment in social interactionn (same as autism)
Restricted, repetitive stereotyped behavior, interests
No clinically significant general delay (CSD) in language
No CSD in cognitive, self-help, or adaptive skills
Asperger Syndromehttp://www.youtube.com/watch?v=Zu4z-ZKZZo4&feature=related
• Normal early development in girls• Head growth deceleration• Loss of purposeful hand movements• Development of "autistic-like" features• Characteristic course• Other unusual Behaviors:
• aerophagia• tongue pulling
•Medical problems:•Scoliosis•movement problems
Rett Syndrome, 1966
Rett Syndrome Video Sample
http://www.youtube.com/watch?v=ZBsEwg_yuDQ&feature=related
Childhood Disintegrative Disorder Heller, 1908
• Period of Normal Development (years)•Usually seen in males• Marked Regression (multiple areas)• Sometimes CNS insult• Usually minimal recovery• Usually as severe or more severe than classic autism•Usually poor long-term prognosis
PDD-NOS
•Atypical autism•More prevalent than classic autism•Are there subgroups/types?•DSM-IV: severe, pervasive impairment
in reciprocal social interaction AND in EITHER:
Verbal or nonverbal communicationRestricted, repetitive stereotyped behavior, interests, or activities
PDD-NOS JK
PDDs in DSM-IV
Always associated with MR Childhood Disintegrative Disorder or Heller’s
syndrome Rett’s Syndrome
May or may not be associated with MR Autism Pervasive Developmental Disorder - Not
Otherwise Specified (PDD-NOS)
Usually not associated with MR Asperger Syndrome (AS) High Functioning Autism (HFA)
Cognition75% of people with ASD function in the
MR RangeConsiderations
Appropriate testStability of scoresScatter is commonIslets of ability
"autistic savants”Improvement with
early intervention
Full Scale IQ Score
<20 20- 30- 40- 50- 60- 70- 80- 90- 100-110-120+
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Savant Abilities or Splinter SkillsDrawing: Nadia, Age 3
Drawing
Stephen Wiltshire
Musical Ability
Blind Tom
Calculation
Mathematics
Calendar
Etiology of Autism
Early focus on parentsPsychodynamic views, Kanner, Bettleheim
BUT evidence againstNo abnormalities in child careNo major personality problemsNo obvious deficits in parenting
By 1970's a large body of evidence favoring neurobiological etiology
Prevalence•Used to be thought rare•Current estimates:
•Autism: 1/1000 - 2/10,000•Is the frequency of autism increasing?
•Rett=s and CDD very rare - ? 1/15,000•Asperger=s - ? 1/7,000•PDD-NOS - ? 1/200
Is the incidence increasing?
No question that more cases are being identified but is there a ‘real’ increase?
Changes in definition Better diagnosis at both ‘ends’ of the
spectrum Growing awareness of the condition Educational implications of label (for
services) Diagnostic substitution
Do vaccines cause autism? Several large, international
epidemiological studies refute association children get vaccines at 18 mo.; ASD often
becomes obvious at this age Autism rates in Japan continued to rise after the
withdrawal of MMR vaccine. Honda et al. No effect of MMR withdrawal on the incidence of autism:
a total population study. Journal of Child Psychology and Psychiatry 2005
Mercury additives said to be cause were removed BEFORE increases in prevalence were seen
Children should be vaccinated; danger of not vaccinating is greater than dangers of inoculation.
Genetics of Autism
•Early impression - no genetics•But condition rare, cases don=t usually reproduce•Subsequent research:
risk in identical twins
rate in sibs (2%)
associated problems in sibs
Functional Classification
High Functioning Includes HFA, AS, and PDD-NOS IQ within or near normal range
but adaptive behavior much lower Fluent, functional language by age 6
Low Functioning Includes Autism, PDD-NOS, Rett syndrome, CDD IQ and adaptive behavior significantly low (<70) No speech, or small single word/sign vocabulary
with a few phrases, mostly rote or echolalic
Developmental Changes
•Preschool: most "classic" autistic features
•Sometimes not all features are exhibited until age 3•Some children respond dramatically to intervention
•School age: social interest & behavior problems•Adolescence:
•gains & losses, seizures onset•Adulthood:
•About 1/3rd have some degree of independence•Many individuals require high levels of support
Predictors of Outcome in Autism
• Presence of communicative speech by age 6
• Outcome worse if child is mute or has speech which is not really used for communication
• Nonverbal IQ in the normal range• Less classic cases (PDD-NOS) = better outcome• Seizures are more common with lower IQ
Outcomes in autism
• 1-2% of cases achieve normal outcome
•Live independently and hold down job• 1/3 have some degree of
independence• 2/3 require high levels of support• Reports of cures should be viewed
with caution• BUT Future outcomes may improve
due to• Earlier detection• Better and more sustained intervention• Mandates for service
Adult Outcome: 1981 vs. 1994
Limitations of available data
DeMyer, et al., 1981
Goode, Rutter, & Howlin, 1994
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Good Fair Poor
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1994
Autism: Shades of Difference Video
http://abcnews.go.com/Video/playerIndex?id=2286327
http://www.autismspeaks.org/video/glossary.php