Pre Training Questionnaire Overview of Autism - Easter Seals
Overview of Autism
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Transcript of Overview of Autism
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Overview of Autism
PS 553 Assessing Autism Interventions
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Overview of Autism
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History of Autismo Term autism originally used by Bleuler (1911)
o To describe withdrawal from social relations into a rich fantasy life seen in individuals with schizophrenia
o Derived from the Greek autos (self) and ismos (condition)
o Leo Kanner – 1943
o Observed 11 children
o Inattention to outside world: “extreme autistic aloneness”
o Similar patterns of behavior in 3 main areas:
1. Abnormal language development and use
2. Social skills deficits and excesses
3. Insistence on sameness
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History of Autismo Psychiatrist Hans Asperger (1944) - describes “little professor” syndrome
oEisenberg and Kanner (1956)
o Added autism onset prior to age 2
o Further refined definition of autism
o Creak (1961)
o Developed 9 main characteristics
o Believed they described childhood schizophrenia
o Incorporated into many descriptions of autism and commonly used autism assessment instruments today
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History of Autismo Rutter (1968)
o Said the term autism led to confusion!
o Argued autism was different than schizophrenia
o Higher M:F ratio
o Absence of delusions & hallucinations
o Stable course (not relapse/marked improvement)
o Further defined characteristics (for science, research)
o National Society for Autistic Children
o One of the 1st & most influential parent groups for children with autism in U.S.
o Wrote separate criteria (for public awareness, funding)
o Added disturbances in response to sensory stimuli & atypical development
o Did not include insistence on sameness
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Diagnostic and Statistical Manual of
Mental Disorders
o Published by the American Psychiatric Association
oClassification of mental disorders used in the US
oInfantile autism included for
first time in DSM-III
oChanged to autism in DSM-III-R
oDSM – IV published in 1994
o Text Revision in 2000
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Pervasive Developmental
Disorderso Come under section in DSM-IV-TR entitled…
o Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
o Includes
o Mental retardation
o Learning disorders
o Motor skills disorders
o Communication disorders
o Pervasive developmental disorders
o Attention-deficit and disruptive behavior disorders
o Feeding and eating disorders of infancy or early childhood
o Tic disorders
o Elimination disorders
o Others: separation anxiety disorder, selective mutism, reactive attachment disorder of infancy or early childhood, stereotypic movement disorder, disorder of infancy, childhood, or adolescence - NOS
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DSM Category: PDDs
Pervasive Developmental Disorders
Autistic
Disorder
Rett’s
Disorder
Childhood
Disintegrative
Disorder
Asperger’s
Disorder
PDD-
Not Otherwise
Specified
• PDDs are characterized by severe and pervasive impairment in 3 main areas
• Social interaction• Communication• Repetitive and restricted behaviors
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Rett’s Disorder
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Childhood Disintegrative Disorder
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Diagnostic Criteria for Autistic Disorder (299.00)
To receive a diagnosis of autism, a child must have at least 6 of the characteristics in the 3 areas
In one of the areas, onset must be before age 3
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DSM Criteria for an Autism Diagnosis: Social Interaction
Must meet 2 of the following:Marked impairment in multiple nonverbal
behaviors (e.g., eye contact, facial expressions)
Failure to develop peer relationships for age
Lack of spontaneous seeking to share enjoyment, interests or achievement with others
Lack of social or emotional reciprocity
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DSM Criteria for an Autism Diagnosis: Communication
Must meet 1 of the following: Delay in, or total lack of, the development of
spoken language (not accompanied by an attempt to compensate through alternative modes of communication)
Marked impairment in ability to initiate or sustain conversation with others
Stereotyped and repetitive use of language Lack of varied, spontaneous make-believe play
or social imitative play appropriate to developmental level
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DSM Criteria for an Autism Diagnosis: Restricted Repetitive and Stereotyped Patterns of Behavior, Interests, and Activities
Must meet 1 of the following: Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that’s abnormal in intensity or focus Inflexible adherence to specific, non-functional
routines or rituals Stereotyped and repetitive motor mannerisms
(e.g., hand flapping, rocking) Persistent preoccupation with parts of objects
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DSM Criteria for PDD-NOS
Severe and pervasive impairment in the development of reciprocal social interaction along with Communication skills OR Presence of stereotyped behavior,
interests, and activities But criteria are not met for any
other PDD
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What are ASDs?
Autism Spectrum Disorders Continuum comprised of autism,
Asperger’s, and PDD-NOS (Volkmar & Klin, 2005)
“the concept of autism is evolving from the singular autistic disorder into the plural autistic spectrum disorders (ASDs)” (Filipek, 2005, p.535)
Wing (1997) said that attempts to differentiate b/w these disordes have been “arbitrary…difficult to apply and unhelpful in clinical practice” (p. 1761)
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DSM V
Proposed Revision of Autism Diagnosis
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94#
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Alex 18 Months Diagnosed with Autism
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First Year of Intervention
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Prevalence
TerminologyIncidence: the number of new
cases of disease in a defined group of people over a specific time
Prevalence: the number of existing disease cases in a defined group of people during a specific time period
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CDC Statistics
Occur in all racial, ethnic, and socioeconomic groups
Four times more likely to occur in boys than in girls
Parents who have a child with an ASD have a 2%–8% chance of having a second child who is also affected.
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CDC Statistics - ASDs In 2003, 62% of the children who had an ASD had at least one
additional disability
Of those children, 68% had mental retardation/intellectual impairment -8% had epilepsy – lower than previous
Other associated features Hyperactivity Short attention span Impulsivity Aggressiveness Self-injury Unusual responses to touch, smell, sound, and other sensory
input. Abnormal eating habits (e.g., selectivity, pica) Abnormal sleeping habits. Abnormal moods or emotional reactions. Gastrointestinal issues
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CDC Statistics - ASDs Some children with ASDs show hints of future problems within
the first few months of life. In others, symptoms may not show up until 24 months or
later. Studies have shown that one third to half of parents of
children with ASDs noticed a problem before their child’s first birthday, and nearly 80%–90% saw problems by 24 months.
Some children with ASDs seem to develop normally until 18–24 months of age and then they stop gaining new language and social skills, or they lose the skills they had.
Children with ASDs develop at different rates in different areas of growth. Splinter skills Delays in one area and age-appropriate in another and in
some cases even advances Inconsistent in how skills get developed
Can read but can’t tell you what sound a “b” makes
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CDC Statistics - ASDs
Can often be detected as early as 18 months.
But national average age of diagnosis was between 4 and 5, now is between 2 and 3
While all children should be watched to make sure they are reaching developmental milestones on time, children in high-risk groups—such as children who have a parent or brother or sister with an ASD—should be watched extra closely…
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Autism and Developmental Disabilities Monitoring (ADDM) Network
The ADDM Network is a group of programs funded by the Centers for Disease Control and Prevention (CDC) to determine the prevalence of ASDs in US communities.
The ADDM Network’s first two ASD prevalence reports were released
2000 6.7 per 1,000 for 8-yr olds 2002 6.6 per 1,000 8-yr olds That’s about 1 in 150 children in these
communities
Lower in Alabama 1:200 Higher in New Jersey 1:94
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New Prevalence Rates In the New York Times
http://www.nytimes.com/2009/12/19/health/19autism.html
From the CDC In 2006: 1 in 110 [males: 1:70; females: 1:315] prevalence of ASDs increased 57% in 10 sites from the 2002
to the 2006 ADDM surveillance year. delays in identification persisted, ASDs were being
diagnosed by community professionals at earlier ages in 2006 than in 2002.
http://www.cdc.gov/ncbddd/autism/index.html http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5810a1.ht
m
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Current Prevalence Rates
Nationwide One in 110 children is estimated to have
autism spectrum disorders nationwide. In Missouri:
934 students diagnosed in 1997 5,777 students in 2009
Since 1992, autism prevalence has increased at an average of 22% each year
It is more prevalent than childhood diabetes, AIDS and cancer COMBINED
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Prevalence of ASD has continued to increase since first survey in 1966 – why?
Increases in requests for serviceChanges in diagnostic criteriaIncreased assessment
opportunitiesBetter awareness by
pediatricians, teachers, parentsAn actual increase in cases?
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Ideally, what does the diagnostic process look like?
Assess all characteristics/abilities3 major areas, adaptive behavior, IQ
Assess in multiple ways with multiple sources Interview, observation, checklist/rating
scalesParent, teacher, professional examiner
Assess over time with multiple observations in multiple settingsHome, school, daycareStructured, unstructured
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Clinical vs. Educational Diagnosis
Clinical diagnosis: conducted by psychologist, neurologist, neuropsychologist Without a clinical diagnosis, a child may still qualify for special
ed services according to federal and state autism disability definition
Educational diagnosis: conducted by school personnel, usually a team, consisting of people who are familiar with the child. Definition of Autism drawn from the Individuals with
Disabilities Education Act (IDEA) Federal law which regulates eligibility, assessment, and
intervention of educational services for children with disabilities
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IDEA definition of Autism
•A developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child's educational performance.
•Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.
•The term does not apply if a child's educational performance is adversely affected primarily because the child has a serious emotional disturbance.
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Videos
Warning Signs of Autism: What Parents Should Look For http://www.autismspeaks.org/video/index.php
Autism Research Todayhttp://www.msnbc.msn.com/id/21134540/vp/32584906#32584906
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Etiology: Psychodynamic Theory
Eveloff (1960) – parents are cold, detached, ritualistic
Bruno Bettelheim (1967) Coined term “refrigerator mothers”
No empirical support
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Etiology: Genetic Evidence
Strong evidence for genetic component, but nature of the component is unknown
Doesn’t look like a single gene Monozygotic twin concordance
high, but less than 100%
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Etiology: Neurotransmitters
Serotonin Some studies have found higher levels in
children with ASD Opioids
Display properties similar to morphine Administration can result in stereotypy,
insensitivity to pain, reduced socialization Some studies have found higher levels in
children with ASD
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Etiology: Vaccines Vaccines
Thimerosal - Preservative used in MMR vaccine used to contain mercury
Wakefield et al. (1998) 12 children with PDD and gastrointestinal disease Purpose was to look at relationship b/w these Participants were selected b/c they had been referred to
a pediatric gastroenterology dept for tx of intestinal problems (e.g., diarrhea, pain, bloating)
Onset appeared to be near time of MMR vaccination Theory…MMR led to impaired intestinal functioning
Permeability of the intestines increased Resulted in excess absorption of peptides from food The peptides have opioid effects Opioid excess led to brain dysfunction, and… Concluded that ASD was caused by MMR vaccine
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Etiology: Vaccines Wakefield Study Methodological Issues
Didn’t discuss specific diagnoses of participants (or how obtained)
The exact onset of intestinal problems wasn’t known Evidence for link b/w behavior changes and MMR was based on
report Correlational study only
Ethical Problems Financial and scientific conflicts that Dr. Wakefield did not
reveal in his paper. For instance, part of the costs of Dr. Wakefield’s research
were paid by lawyers for parents seeking to sue vaccine makers for damages.
Dr. Wakefield was also found to have patented in 1997 a measles vaccine that would succeed if the combined vaccine were withdrawn or discredited.
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Etiology: Vaccines
In 2004, 10 of the 13 authors on the Wakefield et al. study published an article in the same journal (The Lancet) retracting the conclusions made in the original article http://www.childrensimmunisation.com/images/
uploaded/Docs/times_21-02-2004.pdf http://www.oregon.gov/DHS/ph/acd/flu/public/
FluMMRautism.pdf In 2010, the Lancet retracted the study
altogether http://www.nytimes.com/2010/02/03/health/
research/03lancet.html
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Etiology
CDC - Vaccines http://www.cdc.gov/ncbddd/autism/topics.html
ASAT – summary of the vaccine controversy http://www.asatonline.org/pdf/newsletter_preview.pdf
Videos What Causes Autism?
http://www.autismspeaks.org/video/index.php February (2009) court case
http://www.cnn.com/2009/HEALTH/02/11/autism.vaccines/index.html#cnnSTCVideo
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So…what’s the cause of autism?
No one cause of autism has been identified
Genetic influences are likely most important risk factor But not only cause (MZ twin concordance <
100%) Cause is likely multifactorial
Physiology and environment are ALWAYS interacting from day 1
May be several types of autism with different causes