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Transcript of Autism M01
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AUTISM AND OTHER PERVASIVEDEVELOPMENTAL DISORDERS
Online Continuing Education Course
Presented by Care and ComplianceGroup, Inc.
Care and Compliance Group, Inc. and the authors of this course have
attempted to offer useful information and assessment tools that have been
accepted and used by professionals. Nevertheless, changes in the health
care delivery regulations and medical technology will alter the application
of some concepts and techniques presented in this course.
Care and Compliance Group, Inc. and the authors of this course disclaim
any liability, loss, injury, or damage incurred as a consequence, directly or
indirectly, of the use and application of any of the concepts in this course.
All rights reserved. No part of this course may be reproduced or utilized inany form, by any means, electronic or mechanical, including photocopying,
recording, or any information storage and retrieval system, without
permission in writing from Care and Compliance Group, Inc.
Enrolled learners have permission to print the materials in this course for
their own use only as a study aid during their completion of this course.
IMPORTANT NOTICE
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This course presents current information on the Autism
Spectrum Disorders (ASD). Common terminology,
characteristics, screening recommendations, diagnostic
criteria, and management of ASD is presented. Participants
will learn the diagnostic criteria and distinguishing
characteristics of Autism, Asperger's Disorder, and
Pervasive Developmental Disorder-Not Otherwise Specified.
Best practices and intervention planning for individuals of
all ages are discussed.
Course Description
Course Objectives: By the end of this course the participant
will be able to:
Module 1 Objectives:
1. Define the term Autism Spectrum Disorders (ASD).
2. Name the three (3) primary conditions encompassed within the Autism Spectrum Disorders.
3. Discuss the common characteristics or indicators frequently seen inpersons with Autism Spectrum Disorders.
4. Distinguish the differences according to diagnostic criteria for Autistic Disorder, Asperger’s Disorder, and Pervasive DevelopmentalDisorder-NOS.
5. Discuss the causes of ASD.
6. Name the other medical conditions frequently seen in people with ASD.
Course Objectives: Module 1
Continued--
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Course Objectives: By the end of this course the participant
will be able to:
Module 2 Objectives:
1. Discuss key concepts in identifying and managing Autism Spectrum
Disorders.
2. Describe the screening and diagnostic evaluation process as they
relate to Autism Spectrum Disorders in children and adults.
3. Describe treatment options and common procedures for ASDs.
4. Discuss the best practice recommendations for children and adults
with ASDs.
Course Objectives: Module 2
TERMINOLOGY
Various terms related to resident care are used throughout
this course. While most of these terms are commonly
accepted in the industry, there is some variation from state
to state, and within different organizations.
To clarify these terms and to improve your understanding
of their meaning a brief explanation is provided on the
following two pages.
Continued--
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TERMINOLOGY, cont.
Terminology used in this course:
• Community: The care setting is referred to as an assisted living
or residential care community. Although the term "facility" is often
used in state regulations and by some in the industry, we feel it is
important to distinguish a group home, adult residential facility,
and/or an assisted living or residential care residence as a home,
rather than strictly a clinical facility.
– When the word "community" is used in this course it is referring
to the care setting, not the community at large. Clarification will
be provided if necessary. In some cases, such as when quotingfrom regulations, the term facility will be used.
Continued--
TERMINOLOGY, cont.
Terminology used in this course:
• Caregiver: This is the person providing care. Although there are
exceptions, typically this person is not a licensed medical
professional.
• Resident: The resident is the individual receiving care. In other
healthcare settings the term "patient" or "client" are more common,
but to foster a homelike atmosphere the term resident is used in the
assisted living and residential care industries.
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Additional Terminology
Autism: a spectrum disorder which encompasses a range of
neurological afflictions
ASD: autism spectrum disorders (may also be called autistic spectrum
disorders or pervasive developmental disorders)
PDD-NOS: pervasive developmental disorder-not otherwise specified
DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorder-
Fourth Edition, Text Revision
NIMH: National Institute of Mental Health
Let’s review the VERY IMPORTANT DIRECTIONS
before you get started:
• This course is self-paced. Feel free to take as much
time as you need to read each slide.
• You may go forward to the next slide or backwards to aprevious slide within this course.
Welcome!
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• Within this course may be some questions to help you
check your understanding. These questions are not
graded; they are included to help you with the
material.
• At the end of this course is a Final Exam to make
sure you understand the material. You must
complete the Exam to complete the course.
• This course starts with a pretest to help you assessyour knowledge. You must complete the pre-test
before beginning the instruction in the course.
More VERY IMPORTANT DIRECTIONS:
Module 1 IntroductionThis course is divided into two learning modules. In this
first module the information is presented in the following
section topics:
– Introduction
– Statistics
– Autism Spectrum Disorders: Definitions and Types
– Common Characteristics or Indicators of ASD
– History: Autistic Disorder
– History: Asperger’s Disorder
– Research: ASD and the Brain
– ASD and Other Problems
– ASD: Diagnostic Criteria
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INTRODUCTION
• Pervasive Developmental Disorders (PDDs) are also
known as Autism Spectrum Disorders (ASDs). In this
course we will be using the terms interchangeably.
• PDDs cause severe and pervasive impairment in
thinking, feeling, language, and the ability to relate to
others.
• PDDs are usually first diagnosed
in early childhood.
Introduction
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• The term Autism Spectrum Disorders includes five
separate conditions. The first three are the primary
ASDs:
– Autistic Disorder
– Asperger’s Disorder
– Pervasive Developmental Disorder - Not Otherwise
Specified (PDD-NOS)
• These conditions all have some of the same symptoms,but they differ in terms of when the symptoms start,
how severe they are, and the exact nature of the
symptoms.
Introduction, cont.
• The three primary ASDs listed on the previous page,
along with two rare conditions called Rett Syndrome and
Childhood Disintegrative Disorder, make up the broad
diagnosis category of Pervasive Developmental Disorders
(PDD) or Autism Spectrum Disorders (ASD).
Introduction, cont.
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• Autism is the most common of the five Autism Spectrum
Disorders (ASD).
• Although the classic form of autism can be easily
distinguished from other forms of autistic spectrum
disorders, the terms autism and autism spectrum
disorders are often used interchangeably.
Introduction, cont.
• In this course we will focus on the three most common
Autism Spectrum Disorders (ASD): Autism Disorder,
Asperger’s Disorder, and Pervasive Developmental
Disorder-NOS.
Introduction, cont.
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STATISTICS
• Estimates of the prevalence of autism vary widely
depending on diagnostic criteria, age of children
screened, and geographical location.
• State departments of education around the country are
reporting alarming increases in the numbers of children
receiving an autism diagnosis.
• One of the most hotly debated autism topics is whether
rates of incidence are actually rising or if improved
diagnostic techniques account for the rises seen
throughout the country.
Statistics
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• The number of reported cases of autism increased
dramatically in the 1990s and early 2000s, prompting
investigations into several potential reasons:
– More children may have autism; that is, the true frequency of
autism may have increased.
– There may be a more complete finding of cases as a result of
increased awareness and funding.
– The diagnosis may be applied more broadly than before as a
result of the changing definition of the disorder, particularly
changes in DSM-III-R and DSM-IV diagnostic criteria.
– Successively earlier diagnosis in each succeeding cohort of
children, including recognition in preschool, may have affected
apparent prevalence, but not incidence.
Statistics, cont.
• A 2009 study of California data found that the reportedincidence of autism rose 7- to 8-fold from the early1990s to 2007.
– Changes in diagnostic criteria, inclusion of mildercases, and earlier age of diagnosis probably explainonly a 4.25-fold increase.
– The study did not quantify the effects of wider
awareness of autism, increased funding, andexpanding treatment options resulting in parents'greater motivation to seek services.
Statistics, cont.
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• In summary, the reported increase is largely attributable
to changes in diagnostic practices, age at diagnosis, and
public awareness.
• But, these changes apparently do not account for all the
increase in prevalence that is seen.
• Researchers believe that the actual frequency of autismhas increased.
Statistics, cont.
• According to the Centers for Disease Control (February
2007), autism spectrum disorders affect approximately 1
in 150 children (6.6 per 100 children).
• ASD diagnosis commonly occurs between the ages of ten
(10) months and three (3) years of age, with a majority
of diagnoses taking place by the age of one.
Statistics, cont.
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• While ASD diagnosis most commonly occurs prior to the
age of three, there are some children who are not
properly diagnosed until they begin kindergarten at the
age of five (5) or later.
• Some cases of ASD may not be properly diagnosed until
adulthood, even late adulthood.
• Some cases may never be appropriately diagnosed.
Statistics, cont.
• In an effort to avoid these delayed diagnoses, families,
teachers, and others who care for children, especially
children considered at risk for ASD, are familiarized with
assessments, tools, guidelines, and best practices for
detecting ASD.
Statistics, cont.
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• A review of the literature demonstrates that statistical
estimates of the prevalence of ASDs do not always
agree.
– In 2005, the National Institute of Mental Health (NIMH) stated
the "best conservative estimate" as 1 in 1000 persons in the
United States.
– In 2007, the NIMH stated the "best conservative estimate" as 2-
6 in 1000 persons in the United States.
– And, as mentioned before, in 2007 the Centers for Disease
Control (CDC) estimated that ASDs may affect as many as 6.6
per 1000 in the United States.
Varying Autism Spectrum
Disorder Statistics
• Statistical variations aside, the one fact that everyone
agrees upon is that ASDs are being diagnosed with
increasing frequency.
Varying Autism SpectrumDisorder Statistics, cont.
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AUTISM SPECTRUM DISORDERS:
DEFINITIONS AND TYPES
• All autism spectrum disorders are life-long
neurodevelopmental disabilities characterized by:
– An onset of symptoms before 36 months (3 years) that
never “improve.”
• These symptoms remain constant in children and adults
(from young to aging).
Autism Spectrum Disorders(ASDs) Defined
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• All children and adults (including the elderly)
with ASDs demonstrate deficits in:
– Social interaction
– Verbal and non-verbal communications
– Repetitive or ritualistic behaviors or interests
Autism Spectrum Disorders
(ASDs) Defined, cont.
• They will often have unusual responses to sensory
experiences, such as certain sounds or the physical
appearance of certain objects.• Each of these symptoms runs the gamut from mild to
severe and will present differently in each individual
child, adult, and elderly adult.
• ASD’s impact varies significantly from individuals who
are nearly dysfunctional and apparently mentally
disabled to those whose symptoms are mild or remedied
enough to appear unexceptional ("normal") to others.
• Many "high-functioning" people of all ages and/or those
with a relatively high IQ suffering from ASD are under
diagnosed; thus, the assumption that ASD automatically
implies retardation is inaccurate.
Understanding Autism SpectrumDisorders, cont.
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• The five (5) Autism Spectrum Disorders, also known as
pervasive developmental disorders (PDDs), are shown
on the chart on the following slide.
Autism Spectrum Disorders
Autism Spectrum Disorders,cont.
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• The three primary ASDs that are closely related include:
1. Auti st ic D isorder
• Often referred to as:
– Classic Autism
– Traditional Autism
– Typical Autistic Disorder
– Kanner’s Disorder
2. Asperger ’s Disorder (or Asperger Syndrome)
3. Pervasive Developmental Disorder-Not OtherwiseSpecified (PDD-NOS)
• Also known as:
– Atypical Autistic Disorder
– Atypical PDD
Primary Types of Autism
Spectrum Disorders
• Two other ASDs that are rare include:
1 . Ret t Syndrome
• Rare type of ASD
• Not widely recognized by healthcare professionals
2. Chi ldhood Disintegrative Disorder
• Extremely rare type of ASD
• Not widely recognized by healthcare professionals
Rare Types of Autism SpectrumDisorders
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Check for Understanding
Based on Autism Spectrum Disorder Statistics,
reported in 2007 by the Centers of Disease Control,
persons in the United States who deal with some form
of Autistic Spectrum Disorder is:
A. 1 in 1000
B. 1 in a million
C. 1 in 150
Check for Understanding
Based on Autism Spectrum Disorder Statistics,
reported in 2007 by the Centers of Disease Control,
persons in the United States who deal with some form
of Autistic Spectrum Disorder is:
A. 1 in 1000
B. 1 in a million
C. 1 in 150
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COMMON CHARACTERISTICS OR
INDICATORS OF ASD
• The following pages list some of the behavioral characteristics
seen which can be possible indicators of ASDs in children
and/or adults.
• We have presented the characteristics according to age
group; however, many of these characteristics can be seen at
any age.
Common Characteristics orIndicators of ASD
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• Does not babble, point, or make meaningful gestures by
1 year of age
• Does not speak single words by 16 months
• Does not combine two words by 2 years
• Does not understand the concept of pointing - will look
at the hand pointing rather than object to which the
hand points
Possible Indicators of Autism Spectrum
Disorders in Children
Continued-
• Doesn't seem to know how to play with toys
• Excessively lines up toys or other objects
• Doesn't smile
• Consistently cries or absence of crying
• Failure to use 'I', 'me', and 'you', or reversal of these
pronouns
• Delayed toilet training• Limited development of play activities, particularly
imaginative play
Possible Indicators of Autism SpectrumDisorders in Children, cont.
Continued-
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• Likes to spin in a circle
• Overly active, uncooperative, or resistant
• Very independent, even at a very young age
• Gets things for himself/herself only
Possible Indicators of Autism Spectrum
Disorders in Children, cont.
• Tunes others out – not interested in others – in his/her
“own world”
• Unusual attachments to toys, objects, or schedules
• Walks on his/her toes
• Unconcerned about - or completely oblivious to -
dangers around him/her (e.g., standing in the middle of
the street without worrying about getting hit by a car)
Possible Indicators of Autism SpectrumDisorders in Children and Adults
Continued-
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• Unusual responses to other people.
– Shows no desire to be cuddled or hugged
– Has a strong preference for familiar people and may
appear to treat people as objects rather than a source
of comfort.
• Marked repetitive movements, such as hand-shaking or
flapping, prolonged rocking or spinning of objects.
Possible Indicators of Autism Spectrum
Disorders in Children and Adults, cont.
Continued-
• Extreme resistance to change in routines and/or environment
• Avoidance of social situations, preferring to be alone
• Sleeping problems
• Absence of speech, or unusual speech patterns such as
repeating words and phrases (echolalia)
– About half of the children who are non-verbal in the
preschool years will acquire some speech later in life
• Extreme distress caused by certain noises and/or busy public
places such as shopping centers
• Social judgments are difficult
– School behavior problems can often occur.
Possible Indicators of Autism SpectrumDisorders in Children and Adults, cont.
Continued-
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• Ritualistic and compulsive behavior patterns.
• Hyperactivity and a poor attention span are often observed,
usually because the child has trouble understanding
instructions from the teacher and classroom 'rules'.
• Significant levels of anxiety, often from the child's difficulty in
understanding other people and interpreting what is going on
around them.
• Many children will show a lack of motivation or desire to
please others.• Difficulty transferring skills learned in one setting to another
setting (e.g., school to home).
Possible Indicators of Autism Spectrum
Disorders in Children and Adults, cont.
Continued-
• Cannot express or explain what he/she wants
• Does not respond to name
• Regresses in language or social skills
• Stares into open areas, not focusing on anything specific
• Poor eye contact
Possible Indicators of Autism SpectrumDisorders in Children and Adults, cont.
Continued-
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• Doesn’t follow directions
• Has odd movement patterns
• Throws tense or violent tantrums
• Often puts hands on ears
• At times seems to be hearing impaired
Possible Indicators of Autism Spectrum
Disorders in Children and Adults, cont.
• Normal adolescent behavioral challenges and broad mood
fluctuations are exaggerated for those with an Autism
Spectrum Disorder.
– It may start a little later than “normal adolescence” and continue
into late teens and early twenties, but eventually there is a
resumption of calmer behavior.
• A few adolescents show marked improvement in their
behavior and skills, while others may show serious behavioral
regression.
• Sexual development and interest varies with physical
development, but in general is delayed.
Possible Indicators of Autism SpectrumDisorders in Adolescents and Adults
Continued-
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• The commencement of menstruation and sexual drive are
usually tolerated calmly, but exhibitionism and public
masturbation are sometimes problems.
– This behavior can usually be redirected using behavior
modification techniques.
• The presence of a disability seems to become more obvious in
the physical appearance of the older person, especially if they
also have an intellectual disability.
• Epilepsy or seizures may develop in a number of adolescentswith an Autism Spectrum Disorder.
Possible Indicators of Autism SpectrumDisorders in Adolescents and Adults, cont.
Continued-
• Increased levels of anxiety and the development of
depressive symptoms often occur.
– Caregivers need to be alert to this and seek professional
supports for the person.
– Psychotropic medication, as prescribed by a psychiatrist, can
assist with anxiety management.
• If they have received specialist intervention, adults with an
Autism Spectrum Disorder are able to partly overcome theirdifficulties but continue to require sensitive and sustained
support, usually from their families.
Possible Indicators of Autism SpectrumDisorders in Adolescents and Adults, cont.
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• Keep in mind that no ratios are clear-cut in those with
ASD:
– Intellectual disability occurs in at least 70%
– More common in males than females (3:1)
– An accompanying condition of epilepsy is common and can
onset at any age
– Anxiety is common, due to poor communication skills,
over-stimulation, etc.
– May develop behavior disorders
Other Common Characteristics
Check for Understanding
Possible indicators of Autism Spectrum Disorders
in children and adults include all of the following
except:
A. Walks on his/her toes
B. Smiles all the time and loves to have
conversations with peers
C. Doesn’t seem to know how to play with toys
D. Often puts hands on ears
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Check for Understanding
Possible indicators of Autism Spectrum Disorders
in children and adults include all of the following
except:
A. Walks on his/her toes
B. Smiles all the time and loves to have
conversations with peers
C. Doesn’t seem to know how to play with toys
D. Often puts hands on ears
HISTORY: AUTISTIC DISORDER
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• The word "autism" was first used in the English language
in a 1911 issue of the American Journal of Insanity.
• The term was originally used to talk about people who
seemed to have very little social communication with
others.
• Autism was actually confused with schizophrenia during
the early stages of observation.
History of Autistic Disorder
Continued-
• Historically, many behaviors displayed by blind and deaf
children and adults (including the elderly) were seen as
"autistic-like" and attributed to their blindness or
deafness, rather than considering the possibility of
Autism Spectrum Disorders.
History of Autistic Disorder,cont.
Continued-
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Dr. Leo Kanner was an Austrian psychiatrist and
physician. He emigrated to the U.S. in 1924 and became
an Associate Professor of Psychiatry at Johns Hopkins
Hospital in 1933. Dr. Kanner is considered the creator of
the autism classification and published his first paper
identifying autistic children in 1943.
History of Autistic Disorder,
cont.
Continued-
• The classification of “autism” as a separate disorder or
disease did not occur until after Dr. Kanner’s 1943 paper
that suggested the term "autism" to describe the fact
that the children seemed to lack interest in other people.
• Almost every characteristic originally described by Dr.
Kanner is still regarded as typical of the autistic
spectrum of disorders.
History of Autistic Disorder,cont.
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HISTORY: ASPERGER’S DISORDER
• At the same time Dr. Kanner was making his discoveries,
an Austrian scientist named Dr. Hans Asperger made
similar observations, although his name has since
become attached to a different, higher-functioning form
of ASD, known as Asperger syndrome.
History of Asperger’s Disorder
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Dr. Hans Asperger was born on a farm outside of Vienna, earned
his medical degree in 1931, and spent 20 years as the Chair of
Pediatrics at the University of Vienna. In the 1940s, Dr. Hans
Asperger published the first definition of Asperger syndrome in
1944. Dr. Asperger's findings were largely ignored and
disregarded in his lifetime. Finally, in the early 1990s his findings
began to gain notice, and today Asperger syndrome is recognized
as a diagnosis in a large part of the world.
History of Asperger’s Disorder,
cont.
Continued-
• Asperger’s Disorder is diagnosed by the presence of
social interaction impairments and repetitive and
restricted interests.
• There is usually no significant language delay, yet there
are impairments in the social use of language – often
leading to isolation.
• This disorder is more common in males (13:1)*.
*Note: this disorder may be under-diagnosed in females.
Asperger’s Disorder
Continued-
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• While the DSM-IV-TR does not include level of
intellectual functioning in the diagnosis, those with
Asperger's syndrome tend to function better than those
with Autistic Disorder.
• People with Asperger’s Syndrome often have a great
discrepancy between their intellectual and social abilities.
• This fact has produced a popular conception that
Asperger's Syndrome is synonymous with "higher-
functioning autism," or that it is a lesser disorder than
autism.
Asperger’s Disorder, cont.
Continued-
• Children and adults with Asperger Syndrome generally
have few facial expressions apart from anger or misery.
• Most have excellent rote memory and musical ability,
and become intensely interested in one or two subjects
(sometimes to the exclusion of other topics).
Asperger’s Disorder, cont.
Continued-
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• People with this disorder may talk at length about a
favorite subject or repeat a word or phrase many times.
• Children and adults with Asperger’s Syndrome tend to be
"in their own world" and preoccupied with their own
agenda.
• The onset of Asperger’s Syndrome commonly occurs
after the age of three (3).
Asperger’s Disorder, cont.
Continued-
• Some individuals who exhibit features of autism, but
who have well-developed language skills, may be
diagnosed with Asperger’s Syndrome.
• Children with Asperger’s Syndrome have a better
prognosis than those with other pervasive developmental
disorders and are much more likely to grow up to be
independently functioning adults.
Asperger’s Disorder, cont.
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• Clumsiness
• Concrete, pedantic speech (a narrow, often tiresome
focus on or display of book learning and formal rules)
• Lack of common sense
• Intolerance of change
• Anxiety
ypical Characteristics of Asperger’s Disorder in Children and
Adults
• Asperger’s Disorder is thought to be under-diagnosed in
many adults and the elderly.
• The Cambridge Lifespan Asperger Syndrome Service
(CLASS), an organization in the United Kingdom that
works with adults with Asperger's, has developed a
simple ten question checklist to identify the possible
presence of Asperger’s.
Asperger’s Disorder in Adults/Elderly
Continued-
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CLASS checklist, cont.
• Individuals answering “yes” to some or most of these
questions, should consider obtaining input from a
medical professional.
I find social situations confusing.
I find it hard to make small talk.
I did not enjoy imaginative story-writing at school.
I am good at picking up details and facts.
Asperger’s Disorder in
Adults/Elderly, cont.
Continued-
CLASS checklist, cont.
I find it hard to work out what other people are
thinking and feeling.
I can focus on certain things for very long periods.
People often say I was rude even when this was not
intended.
I have unusually strong, narrow interests. I do certain things in an inflexible, repetitive way.
I have always had difficulty making friends.
Asperger’s Disorder in Adults/Elderly, cont.
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• The third primary ASD is Pervasive Developmental
Disorder—Not Otherwise Specified.
• Pervasive Developmental Disorder–Not Otherwise
Specified is included in DSM-IV–TR to encompass cases
where there is marked impairment of social interaction,
communication, and/or stereotyped behavior patterns or
interest, but when full features for another explicitly
defined PDD are not met.
PDD-NOS Defined
Criteria
– Core autistic behaviors are present
– Full criteria for Autistic Disorder or another PDD is not
met
Management
– Management of PDD-NOS is the same as Autistic
Disorder
PDD-NOS Criteria & Management
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• Although PDD-NOS is a well-recognized form of ASD,
studies on PDD-NOS are less common than those on
Asperger’s Disorder and Autistic Disorder.
• PDD-NOS has less diagnostic research on it than any
other ASD.
PDD-NOS Information
Check for Understanding
The following disorder is more common in malesand has a popular conception of being a “higher-functioning autism”, or at least a lesser autisticdisorder.
A. Rett’s Disorder
B. Kanner’s Disorder
C. Childhood Disintegrative Disorder
D. Asperger’s Disorder
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Check for Understanding
The following disorder is more common in malesand has a popular conception of being a “higher-functioning autism”, or at least a lesser autisticdisorder.
A. Rett’s Disorder
B. Kanner’s Disorder
C. Childhood Disintegrative Disorder
D. Asperger’s Disorder
RESEARCH: ASD AND THE BRAIN
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• There is no known single cause for autism.
• It is generally accepted that autism is caused by
abnormalities in brain structure or function. Brain scans
show differences in the shape and structure of the brain
in children with autism versus non-autistic children.
• Researchers are investigating a number of theories,
including the link between heredity, genetics and
medical problems.
Causes of ASD
• Autism does not have a clear unifying mechanism at
either the molecular, cellular, or systems level; it is not
known whether autism is a few disorders caused by
mutations converging on a few common molecular
pathways, or is (like intellectual disability) a large set of
disorders with diverse mechanisms.
Causes of ASD, cont.
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• Because of its relative inaccessibility, scientists have only
recently been able to study the brain systematically. But
with the emergence of new brain imaging tools the study
of the structure and the functioning of the brain can now
be done.
• Postmortem and MRI studies have shown that many
major brain structures are implicated in autism. This
includes the cerebellum, cerebral cortex, limbic system,
corpus callosum, basal ganglia, and brain stem. Otherresearch is focusing on the role of neurotransmitters
such as serotonin, dopamine, and epinephrine.
Research
• ASD affects many parts of the brain.
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Major Brain Structures Implicated in
Autism, cont.
• Recent neuroimaging studies have shown that a
contributing cause for autism may be abnormal brain
development beginning in the infant’s first months. This
“growth dysregulation hypothesis” holds that the
anatomical abnormalities seen in autism are caused by
genetic defects in brain growth factors.
• Autism appears to result from developmental factors that
affect many or all functional brain systems, and to
disturb the timing of brain development more than the
final product.
ASD and The Brain
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• The heads of children with ASD tend to be “larger than
what is considered normal” and researchers confirm that
these children have bigger and heavier brains than those
children without ASD.
– This occurs at the 1-2 month mark, as babies with ASD are born
with smaller heads, but they rapidly grow.
– It is possible that sudden, rapid head growth in an infant may be
an early warning signal that will lead to early diagnosis and
effective biological intervention or possible prevention of autism.
• By the age 18, the brain in a majority of people with
ASD is of normal weight.
ASD and The Brain, cont.
• Research into the causes of autism spectrum disorders is
being fueled by other recent developments. Evidence
points to genetic factors playing a prominent role in the
causes for ASD. Twin and family studies have suggested
an underlying genetic vulnerability to ASD.
ASD and Genetics
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• The Institute of Medicine (IOM) conducted a thorough
review on the issue of a link between thimerosal (a
mercury based preservative that is no longer used in
vaccinations) and autism. The final report from IOM,
Immunization Safety Review: Vaccines and Autism,
released in May 2004, stated that the committee did not
find a link.
ASD and Vaccines
• A U.S. study looking at environmental factors including
exposure to mercury, lead, and other heavy metals is
ongoing.
ASD and Environmental Factors
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• Much of ASD remains a mystery, and some researchers
are focusing on environmental factors, as others
continue to investigate genetics. Current theory holds
that ASD results from a combination of genetics and
environmental factors.
Causes of ASD
Check for Understanding
Based on research, which of the followingstatements is false?
A.No single cause for ASD is known
B.Environmental factors are being studied to determine
their role in ASD
C.Genetic factors are thought to pay a role in the causes of
ASD
D.None; all of the above are true
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Check for Understanding
Based on research, which of the followingstatements is false?
A.No single cause for ASD is known
B.Environmental factors are being studied to determine
their role in ASD
C.Genetic factors are thought to pay a role in the causes of
ASD
D.None; all of the above are true
ASD AND OTHER PROBLEMS
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• People who have ASD often have other medical or
behavioral problems. Some of the most common are
described in this section.
ASD and Other Problems
• Sensory problems. Many ASD children are highly attuned or even
painfully sensitive to certain sounds, textures, tastes, and smells. In
ASD, the brain seems unable to balance the senses appropriately.
– Some children find the feel of clothes touching their skin almost
unbearable.
– Some sounds—a vacuum cleaner, a ringing telephone, a sudden
storm, even the sound of waves lapping the shoreline—will
cause these children to cover their ears and scream.
– Some ASD children are oblivious to extreme cold or pain.
– An ASD child may fall and break an arm, yet never cry. Another
may bash his head against a wall and not wince, but a light
touch may make the child scream with alarm.
ASD and Other Problems, cont.
Continued--
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• Mental retardation. Many children with ASD have
some degree of mental impairment.
• Seizures. One in four children with ASD
develops seizures, often starting either
in early childhood or adolescence.
ASD and Other Problems, cont.
Continued--
• Tuberous Sclerosis. Tuberous sclerosis is a rare
genetic disorder that causes benign tumors to grow in
the brain as well as in other vital organs. It has a
consistently strong association with ASD. One to 4
percent of people with ASD also have tuberous sclerosis.
ASD and Other Problems, cont.
Continued--
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• Fragile X syndrome. This disorder is the most
common inherited form of mental retardation. It was so
named because one part of the X chromosome has a
defective piece that appears pinched and fragile when
under a microscope. Fragile X syndrome affects about
two to five percent of people with ASD. It is important to
have a child with ASD checked for Fragile X, especially if
the parents are considering having another child.
ASD and Other Problems, cont.
ASD: DIAGNOSTIC CRITERIA
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• Accurate diagnosis of Autism Spectrum Disorder is
important for a number of reasons, including:
– Assessment can assist in understanding why someone
is “different” and understand his/her strengths,
challenges, and needs
– Early intervention and appropriate educational
programs can be implemented
– Access to support services can be facilitated
Diagnosis of ASD
• Common difficulties encountered with the management
of ASD in children and adults are:
– Difficult behavior, such as tantrums, obsessions,
aggression, etc.
– Communication problems
– Disturbed routine, such as sleep or finicky eating
– Social issues such as inappropriate behavior, isolation,
teasing, bullying, etc.
Influences in Behavior
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• The Diagnostic and Statistical Manual of Mental Disorder
– Fourth Edition (DSM-IV-TR), published by the
American Psychiatric Association, Washington, D.C. is
the main diagnostic reference of mental health
professionals in the United States.
• The DSM-IV-TR outlines specific diagnostic criteria for
each of the five Autism Spectrum Disorders (ASDs), also
called Pervasive Developmental Disorders (PDDs).
DSM-IV-TR Criteria
• All of the Pervasive Developmental Disorders are
characterized by severe and pervasive impairment in
several areas of development including:
1. reciprocal social interaction skills
2. communication skills, or
3. the presence of stereotyped behavior, interests, and
activities.• The qualitative impairment that define the different ASD
conditions are described in the following pages.
All PDDs
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• The following pages present the specific diagnostic
criteria that is found in the DSM-IV-TR for all 5 of the
Autism Spectrum Disorders.
Diagnostic Criteria
A. 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 postures, and
gestures to regulate social interaction.
b) Failure to develop peer relationships appropriate to
developmental level.
c) Lack of spontaneous seeking to share enjoyment, interests, or
achievements with other people.
d) Lack of social or emotional reciprocity.
DSM-IV-TR Criteria299.00 Autistic Disorder
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(2) Qualitative impairments in communication, as manifested
by at least one of the following:
a) Delay in, or total lack 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 individuals 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.
DSM-IV-TR Criteria
299.00 Autistic Disorder, cont.
(3) Restrictive, 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 focus.
b) Apparently inflexibility adherence to specific, nonfunctional
routines or rituals.
c) Stereotyped and repetitive motor mannerisms.
d) Persistent preoccupation with parts of objects.
DSM-IV-TR Criteria299.00 Autistic Disorder, cont.
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B. Delays or abnormal functioning in at least one of the
following areas, with onset prior to age three years:
– Social interaction
– Language as used in social communication
– Symbiotic or imaginative play
C. The disturbance is not better accounted for by Rett’s
Disorder or Childhood Disintegrative Disorder.
DSM-IV-TR Criteria
299.00 Autistic Disorder, cont.
All areas must be met to qualify:
(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 postures, and
gestures to regulate social interaction.
b) Failure to develop peer relationships appropriate to
developmental level.c) Lack of spontaneous seeking to share enjoyment, interests, or
achievements with other people.
d) Lack of social or emotional reciprocity.
DSM-IV-TR Criteria299.80 Asperger’s Disorder
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(2) Restrictive, 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 focus.
b) Apparently inflexibility adherence to specific, nonfunctional
routines or rituals.
c) Stereotyped and repetitive motor mannerisms.
d) Persistent preoccupation with parts of objects.
DSM-IV-TR Criteria
299.80 Asperger’s Disorder, cont.
(3) The disturbance causes clinically significant impairment in
social, occupational, or other important areas of
functioning.
(4) There is no clinically significant general delay in language
(e.g. single words used by age 2 years, communicative
phrases used by age 3 years).
(5) There is no clinically significant delay in cognitive
development or in the development of age-appropriateself-help skills, adaptive behavior (other than in social
interaction), and curiosity about the environment in
childhood.
(6) Criteria are not met for another specific pervasive
developmental disorder or schizophrenia.
DSM-IV-TR Criteria299.80 Asperger’s Disorder, cont.
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• This category should be used when there is a severe and
pervasive impairment in the development of reciprocal
social interaction associated with impairment in either
verbal and nonverbal communication skills, or with the
presence of stereotyped behavior, interests, and
activities, but the criteria are not met for a specific
pervasive developmental disorder, schizophrenia,
schizotypal personality disorder, or avoidant personality
disorder.
DSM-IV-TR Criteria - 299.80 PervasiveDevelopmental Disorder, Not Otherwise
Specified (PDD-NOS)
A. All areas must be met to qualify:
1. Apparently normal prenatal and perinatal development.
2. Apparently normal psychomotor development through
the first 5 months after birth.
3. Normal head circumference at birth.
DSM-IV-TR Criteria299.80 Rett’s Disorder
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B. Onset of all of the following after the period of normal
development:
1. Declaration of head growth between ages 5-48 months.
2. Loss of previously acquired purposeful hand skills between
ages 5-30 months with the subsequent development of
stereotyped hand movements (e.g., hand-wringing or hand
washing).
3. Loss of social engagement early in the course (although social
interaction often develops later).
4. Appearance of poorly coordinated gait or trunk movements.
5. Severely impaired expressive and receptive language
development with severe psychomotor retardation.
DSM-IV-TR Criteria
299.80 Rett’s Disorder, cont.
A. Apparently normal development for at least the first 2 years after
birth as manifested by the presence of age-appropriate verbal and
non-verbal communication, social relationships, play, and adaptive
behavior.
B. Clinically significant loss of previously acquired skills (before age 10
years) in at least two of the following areas:
1. Expressive or repetitive language
2. Social skills or adaptive behavior
3. Bowel or bladder control
4. Play
5. Motor skills
DSM-IV-TR Criteria - 299.10Childhood Disintegrative Disorder
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C. Abnormalities of functioning in at least two of the following
areas:
1. Qualitative impairment in social interaction (e.g. impairment innonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity).
2. Qualitative impairments in communication (e.g. delay or lack of spoken language, inability to initiate or sustain a conversation,stereotyped and repetitive use of language, lack of varied make-believe play).
3. Restricted, repetitive, and stereotyped patterns of behavior,
interests, and activities, including motor stereotypes andmannerisms.
D. The disturbance is not better accounted for by another specific
pervasive developmental disorder or by schizophrenia.
DSM-IV-TR Criteria - 299.10 Childhood
Disintegrative Disorder, cont.
• As previously noted in this presentation – please
remember that there is much to learn about ASD and
that the information presented is the best available at
this time.
Disclaimer Notice
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• This is the end of the information in Module 1.
• In this module you learned:
– The terminology, definitions, and the five conditions associatedwith Autism Spectrum Disorders (ASD).
– Common characteristics or indicators frequently seen in personswith Autism Spectrum Disorders.
– The differences in diagnostic criteria for each of the five ASDs.
– The causes of ASD.
– Other medical conditions frequently seen in people with ASD.
Summary: Module 1
Module 2 Content
In Module 2 we will build upon the information you learned
in this module. In Module 2 we will discuss:
– Key concepts in identifying and managing Autism Spectrum
Disorders.
– The screening and diagnostic evaluation process as they relate
to Autism Spectrum Disorders in children and adults.
– Treatment options and common procedures for ASDs.
– Best practice recommendations for children and adults with
ASDs.