Autism Spectrum Disorders: An Introduction

Rhea Paul, Ph.D., CCC-SLPSouthern Connecticut State University

Yale Child Study CenterFeb. 11-15, 2008

rhea.paul@yale.eduwww.autism.fm

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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Autism: Shades of Difference Video

http://abcnews.go.com/Video/playerIndex?id=2286327

http://www.autismspeaks.org/video/glossary.php