WHAT IS AUTISM?

PDD

Autistic Disorder

Asperger’s Disorder

Rett’sDisorder

ChildhoodDisintegrative Disorder

PDDNOS

Pervasive Developmental Disorder (PDD) is a neurological disorder

that affects a child’s ability to communicate, understand

language, play, and relate to others.

PDD represents a distinct category of developmental disabilities that

share many of the same characteristics that fall within the

broad meaning of PDD:• Autistic Disorder

• Asperger’s Disorder

• Rett’s Disorder

• Childhood Disintegrative Disorder

• Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)

IDEA

“Autism” is one of the disabilities specifically defined in IDEA as “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.”

A diagnosis of autistic disorder is made when an individual has impairments in each of the three major areas:

1) Social Interaction

2) Communication

3) Behavior

Social Interaction

Behavior

TRIAD OF

IMPAIRMENT

Communication

Social Interaction• Difficulty relating to people, objects and

events:– Impairment in the use of nonverbal behaviors

(inability to “read” other people)– Lack of social and emotional reciprocity (Use

of parents as tools to get what they want; treat people and objects alike)

– Exhibits avoidant behaviors (minimal eye contact, minimal attention to people/events)

– Fails to develop relationships (no social initiative)

Social Interaction

• Unusual play with toys and other objects– Uses toys in a mechanical fashion (toys are

lined up, sorted, twirled or hurled, but not used for imaginative games)

– Typically does not point to toys or objects– Lacks spontaneous make-believe play (no

imitation of day-to-day activities)

Communication

• Difficulty using and understanding language– Failure to develop reciprocal language (unable to

grasp the concept that speech can be used to name objects, to request a toy, or to engage others)

– Stereotypic speech (echolalia and delayed echolalia-repeats rhymes, jingles, or what other individuals have said; Pronoun reversal-talks in third person; unusual inflections and intonations-robotic speech)

– Idiosyncratic language (no understanding of the conventional meaning of any individual words)

– Talks in “chunks” (chunked phrases replace one-word utterance in early language development-repeats commercials, movies or others’ speech)

Communication

– Pragmatic difficulties (difficulties sustaining a conversation, turn taking, and allowing the conversational partners to introduce their topics)

Repetitive or Stereotypic Behaviors

• Difficulties with changes in routine or familiar surroundings (rigid need for “sameness” in daily routines)– Development of elaborate rituals in which the order of

events, the exact words, and the arrangement of objects must be followed

• Repetitive body movements or behavior patterns– Stereotypic movements (hand clapping, arm flapping,

aimless running, rocking, spinning, licking, flicking fingers, flicking pages of books, etc.)

Repetitive or Stereotypic Behaviors

• Pronounced sensory issues (either overreaction or underreaction to sensory stimulation)– Sound – Touch and textures – Tastes– Smells

• These behaviors may have a calming/soothing effect that surface in times of stress

ADOSAutism Diagnostic Observation

Schedule

• A Semi-Structured Standardized Assessment of :

Communication

Social Interaction

Play or Imaginative Use of Materials

Medical DX vs. Educational Eligibility

Medical Diagnosis

− DSM IV

− Clinical Judgment

− Rating Scales Observations

Educational

Identification

− IDEA Regulations

− Team Assessment

− Structured

ADOS

4 Modules for:

Development & Language Levels

Module 1: No speech to simple phrases

Module 2: Meaningful 3-word phrase with verb

Module 3: Verbally fluent (Child/Adolescent)

Module 4: Verbally fluent (Adolescent/Adult)

ADOS as a Clinical Instrument

• Creates a “social world”

• Structured and unstructured activities

• Guidelines for a “hierarchy” of examiner’s behavior and verbal prompts

• Flexibility of instrument and examiner

• Dependent on examiner’s experiences and sensitivity (to act and not to act)

ADOS Administration

• Time: 30 – 45 minutes

• Work as a Team

• Practice = Reliability