UNDERSTAND THE AUTISM

DEFINITION

ITS A developmental disability significantly affecting Verbal

nonverbal communication
social interaction generally evident before age three

CHARACTERSTICS
engagement in repetitive activities

stereotyped movements
resistance to environmental change

change in daily routines

unusual responses to sensory experiences

Sensory issues
Over or under-sensitivity to noises, lighting, odors, tastes, textures, pain Sensory over-selectivity Failure to respond Hidden senses

vestibular (movement and balance) proprioceptive (feedback on how much force or pressure to apply when picking up something or holding an item)

Cognitive issues

Difficulty drawing conclusions Difficulty with incidental learning Often excellent rote memory Slower at retrieving information Slower processing speed Problems with working memory Trouble predicting outcomes (e.g., peoples reactions) Often do not see cause-effect

Cognitive issues continue

Problems with executive function

Issues with shift: moving freely from one activity/situation to another, transitions, flexible problem solving Issues with initiation; cant begin tasks Issues with planning, organizing, sequencing, setting goals/objectives Issues with seeing big picture or main idea Issues with evaluating activity; pace, completion, Issues with modulating emotional response Issues with controlling impulses

History of Autism
o 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

History of Autism
o Psychiatrist Hans Asperger (1944) - describes little professor syndrome o Eisenberg 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

History of Autism
o 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

Myths
Individuals with autism never make eye contact Autism is a mental illness. Individuals with autism do not speak. Autism can be outgrown. Individuals with autism cannot learn autistic children are retarded. Autism can be completely cured. Autistics have no sense of humour.

Myths
inside a child with autism is a genius. Individuals with autism are very manipulative. Individuals with autism cant smile; cannot show affection do not want friends do not learn Autism is caused by poor parenting and a lack of initial bonding.

Prevalence of Autism
2-6 cases per 1,000 growing at a rate of 10-17

percent per year

diagnostic boundaries have changed inclusion of spectrum Increasing recognition of comorbidity (e.g. Downs, Tourette syndrome, cerebral palsy) Improvements in case-finding methods Populations sampled Increased public awareness Introduction of the MMR vaccine

boy:girl- 4:1(more severe in girls) Usually identified before 30 months No racial or socioeconomic differences

CAUSES

Monozygotic vs. dizygotic twin studies have shown that if 1 identical twin has autism, the chance that the other twin has autism is 10 times higher than that of fraternal twins

Neurotransmitters

Serotonin Opioids

Some studies have found higher levels in children with ASD

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

CAUSES

Other Theories: Heavy metals Pollutants Toxins Vaccines Chemicals Pesticides Gastrointestinal issues *none of these have been empirically proven to cause autism*

high risk parameters

Siblings of children with ASD: 10 x increased risk Premature Infants Comorbid Genetic Syndromes: e.g. Fragile X syndrome, Tuberous Sclerosis Prenatal Exposures e.g. Valproic acid

Early Development

communication and relating to other people followed by socialemotional development of baby is key to form strong relationships and continued learning which starts from the birth itself

By the end of 3 months

Begin to develop a social smile Enjoy playing with other people and may cry when playing stops Become more expressive and communicate more with face and body Imitate some movements and facial expressions

By the end of 7 months

Smile back at another person Respond to sound with sounds Enjoy social play

By the end of 12 months

Use simple gestures (pointing, showing, waving bye,) Imitate actions in their play Respond when told no Start babbling mama, dada, baba

By the end of 18 months

Do simple pretend play Point to interesting objects Use several single words unprompted

By the end of 2 years

(24 months)
Use 2- to 4-word phrases Follow simple instructions Become more interested in other children Point to object or picture when named

Role of physician/ Counselor

Early recognition based on

Knowledge of signs and symptoms Developmental surveillance and screening

Guiding families to diagnostic resources and intervention services Conducting a medical evaluation Providing ongoing health care Supporting and educating families

DIAGNOSIS
Major areas Communication Socialization Behavior

Communication

Delay in, or complete lack of, verbal communication Difficulty in initiating or sustaining conversations Stereotyped or idiosyncratic use of language (echolalia, jargon) Inability to engage in spontaneous, make- believe, or imitative play at the appropriate developmental level

Socialization

Difficulty developing peer relationships appropriate to developmental level Impaired use of nonverbal behaviors (e.g., eye contact, facial expressions, and gestures) Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (joint attention) Lack of social or emotional reciprocity

Behavior

Preoccupation with an activity or interest that is abnormal either in intensity or focus Inflexible adherence to nonfunctional routines or rituals Repetitive or stereotyped movements (e.g., hand flapping) Persistent preoccupation with parts of objects

Treatment

Goals

Minimize core features and associated deficits

Maximize functional independence Alleviate family stress

Speech and language therapy Redesign of education pattern Educate the parents/ guardian/ siblings Conduct applied behavioral analysis (ABA) and treat according to the score

ABA : It is the repetitive use of positive reinforcement to teach specific skills and decrease inappropriate behaviors.

Son-Rise Program encourages providers and parents to teach with enthusiasm and to employ a non-judgemental attitude.

floor time treatment

Floor Time is simply the idea that a childs communication skills can be improved by building on his/her strengths while playing together on the floor. Pivotal Response Treatment to teach language, decrease inappropriate behaviors, and increase social skills and academics.

Psychopharmacology
Symptoms/ Disorders Attentional, impulsivity, hyperactivity Anxiety Depression Obsessive compulsive symptoms

Freq
59%

Treatments
Behavioral intervention Psychopharmacotherapy stimulants, atomoxetine, alpha agonists, anti-anxiety Behavioral treatment relaxation, cognitive Psychopharmacotherapy SSRI, alpha agonist Psychotherapy Medication anti-depressants Behavioral treatment, supportive counseling; Medication SSRI, others

43-84% 2-30% 37%

Disruptive, irritable or aggressive behavior

Self-injurious behavior Tics Sleep disruption

8-32%

Behavioral intervention Medication atypical neuroleptics (risperidone, arapiprazole, others)

Behavioral intervention Medication (e.g., naltrexone, risperidone, others) Medications; Alpha agonist (clonidine, guanfacine), others Sleep diary; sleep hygiene; behavioral supports; investigate possible medical comorbidity/ies as cause(s)

34% 8-10% 52-73%