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Autism 101:An Introduction for Families

Lindsey Miller, ARNPRachel Montague, Ph.D.

June 5, 2012

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• What are Autism Spectrum Disorders?• Prevalence & causes• Characteristics & related issues• Treatments• Resources

Overview of Presentation

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What Are Autism Spectrum Disorders?• ASDs are brain-based

developmental disorders that are present from birth and includes presence of • Social,• communicative, • and behavioral abnormalities

(Diagnostic and Statistical Manual, IV (DSM-IV))

Overview of Presentation

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• Symptoms can occur in a variety of combinations

• Symptoms present with varying degrees of severity

• Two children with a diagnosis of autism can have very different strengths and challenges and can act completely differently from one another

• Intellectual abilities vary

What is meant by “spectrum disorders”?

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Autism Triad – Current Model

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Autism Spectrum Disorders

Autistic Disorder Asperger's Disorder PDD-NOS

What are Autism Spectrum Disorders (ASD)?

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Autism – Proposed Model

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Autism Spectrum Disorder

Autistic Disorder Asperger's Disorder PDD-NOS

Proposed model of ASD

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• CDC estimates that 1 in 88 children have ASD• This is up to a 10-fold increase since 1950s

• Similar rates across different cultures, ethnicities, or income level

• Current averages indicate

that boys are 4.4 times

more likely to be

diagnosed with ASD as

compared to girls

Prevalence of ASD

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Why the increase in ASDs?

• Several reasons:• Wider public awareness• Better assessment tools• We are now diagnosing kids with autism now who

present with average or above average intellectual capabilities and more subtle social and language delays.

• Is there a true increase?• ASDs may have been unrecognized or misidentified

in the past

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What causes it?

• Genetics• Identical twin studies: 60-90% of the time that 1 twin

has ASD, the other does too.

• For sibling studies: 8-18% of the time that 1 sibling has ASD, another sibling does too.

• Even if the other siblings don’t meet criteria for ASD, they may have social difficulties, language impairment or developmental delay

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What causes it?

• Environment• There is also likely an environmental component

• research is trying to identify specific environmental factors

• What do we mean by “environment”?

• It’s likely a combination of genetics & environment• The theory is that the genetic component can be

turned on by an environmental trigger.

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What causes it?

• We know some things do NOT cause ASD – such as vaccines or parenting• In 2010, journal Lancet officially retracted the 1998

article that originally suggested a connection between autism and the MMR vaccine.

• Many years ago, people believed autism was caused by “bad parenting.” Research has shown that is not the case.

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When is ASD diagnosed?

• ASD can sometimes be diagnosed as early as age 2 by experienced clinicians

• Some children with ASD are diagnosed during school-age years.

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How is ASD diagnosed?

• No medical test (e.g. blood test, brain scan)• Diagnosis made using specific criteria • Based on developmental history, direct observation

and interaction with child, clinical judgment by qualified professionals

• Tools:• Autism Diagnostic Observation Schedule (ADOS) often used,

but not required• Autism Diagnostic Interview (ADI) – semi structured parent

interview about development

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Characteristics of ASDs

Social Interaction Impairments

Restricted, Repetitive Behaviors

Communication Impairments

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Social Interaction Impairment

• Difficulty using eye gaze, gestures, etc.• Gestures include pointing, nodding, waving goodbye

• Few friendships• Difficulty sharing enjoyment & interests

with others.• Difficulty relating to others, taking

another’s perspective, and empathy

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Communication Impairment

• Language delays• Difficulty with back-and-forth

conversations.• Repetitive and/or odd use of language.

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• Abnormally obsessive interests• Rigid adherence to routines• “Stereotyped” motor movements

• Hand flapping, rocking, spinning, pacing

• Focus on the details, miss the big pictures

• Odd play skills

Patterns of Behavior

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Related Issues in ASD

• Inattention and/or Hyperactivity (ADHD)• Anxiety• Depression/ irritability • Disruptive/ oppositional behaviors• Sensory Processing Issues

• Motor Planning Issues

• Executive Functioning

• Tic disorders

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• Visual learning• Concrete skills• Memory• Consistency• Following rules• Attention to detail

Common Strengths for Children with ASD

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• There is no cure for ASD, but intervention lead to improvement and development of skills.

• Intervention is recommended as soon as diagnosis is made.

• With intervention, progress can be made in many areas.

• What therapy is right for your child?

Interventions for children with ASDs

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• Children with ASD may qualify for special education services from birth to age 21• Birth-to-Three Services for children under 3• Individual Education Program (IEP) for children 3 to 21• Depending on child’s needs, extra services may

include:• speech language therapy, occupational therapy, social

skills groups, and/or academic support• Inclusion and self-contained placements• Behavior support or positive behavior planning

School Services

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Special Education Resources

• WAC codes (Washington Administrative Code) http://www.k12.wa.us/specialed/

• Wrightslawhttp://www.wrightslaw.com/

• Special Educational Ombudsman Office http://www.governor.wa.gov/oeo/

• Autism Speaks IEP Guide: http://www.autismspeaks.org/family-services/ community-connections/back-to-school

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Private Therapies

• Speech & Language Therapy• Occupational Therapy (sensory, fine motor)• Physical Therapy (gross motor, coordination)• Individual Therapy / Counseling• Social Skills Groups• Biomedical Treatments• Family Education & Therapy / Counseling• Parent Training & Information

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Speech & Language Therapy

• Communication Development• Talking and understanding what others are saying• Production of speech sounds (articulation)• Social Communication – “how and why we

communicate”• Nonverbal Communication

• School-based and private speech language pathologists

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Occupational (OT) & Physical Therapy (PT)

• Gross Motor Development – “large” motor movements -- PT• E.g., running/jumping

• Fine Motor Development – “small” motor movements -- OT• E.g., using utensils/tools

• Sensory Processing• School-based and private OT/PT

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Individual Therapy

• Common types of individual therapy:• Cognitive Behavior Therapy (CBT)

• Child learns how thoughts, feelings and behaviors are connected

• Child learns coping skills for anxiety, anger, teasing, etc.

• Behavior Management• Parents learn why child has certain behaviors and learns

strategies to improve the child’s behaviors• Applied Behavior Analysis (ABA)

• Can be provided by Masters level therapist or Ph.D. (psychologist)

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• Group of approximately 4-8 children with social skills difficulties, led by a therapist / teacher

• Focus on development of social skills• making friends, starting and ending conversations,

etc.• School-based and private groups• Excellent opportunity to practice skills learned in

individual therapy!

Social Skills Groups

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Common Medical Issues in ASD

• Picky Eating

• GI (stomach, poop, etc.) Problems

• Seizures

• Sleep Disturbances

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Biomedical

• Medications can be used to treat some behaviors associated with ASD• Inattention, hyperactivity, aggression, irritability,

anxiety

• Complementary & Alternative Medicine (CAM)• Be careful to evaluate treatments prior to beginning,

and talk to your doctor

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Parent Support

• Parent groups• FEAT of Washington

• http://www.featwa.org/

• Autism Society of Washington• http://www.autismsocietyofwa.org/

• ALLY support group at Seattle Children’s Autism Clinic• Email lynn.vigo@seattlechildrens.org for information

• TACA of Washington• http://www.tacanow.org/local-chapters/washington/

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Seattle Children’s Autism Center

• How to get in:• Talk to your Primary Care Provider for referral

• Services offered:• Diagnosis• Medical treatment (psychiatry, neurology,

neurodevelopmental, speech)• Individual therapy (cognitive behavioral, behavior

management)• Treatment planning

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General Resources – Local

• SCH Autism Center• Autism Blog: www.theautismblog.org• Information and Resources:

http://www.seattlechildrens.org/clinics-programs/autism-center/

• Autism Outreach Project• http://www.nwesd.org/autism

• Autism Society of Washington• http://www.autismsocietyofwa.org

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General Resources – National and International

• Autism Speaks• www.autismspeaks.org

• Autism Society of America:• www.autism-society.org

• Global Autism Collaboration (Center for the Study of Autism):• www.autism.org

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• Division of Developmental Disabilities (DDD)• Apply for eligibility/services• May receive services (although limited at this time)• Important to apply now so children may receive services in

future• http://www.dshs.wa.gov/ddd/• Tuesdays at 11am – free DDD application help at SCAC

• Supplemental Security Income (SSI)• May be eligible for disability income• http://www.ssa.gov/ssi/

Government Resources

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Video Recommendations

• Autism Resource DVD, produced by University of Washington’s Autism Clinic

• Watch or download at• http://

depts.washington.edu/uwautism/resources/autism-resource-dvd.html

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Book Recommendations

• Educating Children with Autism• National Research Council

• My Social Stories Book• Carol Gray

• More than Words• Fern Sussman

• A Parents’ Guide to Asperger and High Functioning Autism• Sally Ozonoff, Geraldine Dawson, and James McPartland

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