Transcript Assessing Young Children with Social

Autism Spectrum Disorders: An
Introduction
Rhea Paul, Ph.D., CCC-SLP
Southern Connecticut State University
Yale Child Study Center
Feb. 11-15, 2008
[email protected]
www.autism.fm
Another Way to Look at it
Autistic Disorder
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Impairment in social interaction-at least 2 of:
Onset before age 3
 Gaze, facial expression, gesture impairments
 Failure to develop peer relationships
 Lack of seeking to share with others
 Lack of reciprocity
Impairment in communication-at least 1 of:
 Delay in language
 Impairment in conversation ability
 Stereotyped and repetitive langauge
 Lack of pretend play
Restricted, repetitive stereotyped behavior, interests, activities-at least 2 of:
 Preoccupations with abnormal focus or intensity
 Rigid need for routine or ritual
 Motor mannerisms
 Preoccupation with parts of objects
Autistic Disorder- 3 Examples
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http://www.youtube.co
m/watch?v=kSB_BQgO
Ex0&feature=related
Asperger Syndrome in DSM-IV
 Impairment
in social interactionn (same as
autism)
Restricted, repetitive stereotyped behavior,
interests
 No clinically significant general delay (CSD) in
language
 No CSD in cognitive, self-help, or adaptive skills
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Asperger Syndrome
http://www.youtube.com/watch?v=Zu4zZKZZo4&feature=related
Rett Syndrome, 1966
• Normal early development in girls
• Head growth deceleration
• Loss of purposeful hand movements
• Development of "autistic-like" features
• Characteristic course
• Other unusual Behaviors:
• aerophagia
• tongue pulling
•Medical problems:
•Scoliosis
•movement problems
Rett Syndrome Video Sample
http://www.youtube.com/watch?v=ZBsEwg_yuDQ&feature=related
Childhood Disintegrative Disorder
Heller, 1908
• Period of Normal Development (years)
•Usually seen in males
• Marked Regression (multiple areas)
• Sometimes CNS insult
• Usually minimal recovery
• Usually as severe or more severe than classic
autism
•Usually poor long-term prognosis
PDD-NOS
• Atypical autism
• More prevalent than classic autism
• Are there subgroups/types?
• DSM-IV: severe, pervasive impairment in
reciprocal social interaction AND in EITHER:
Verbal or nonverbal communication
Restricted,
repetitive stereotyped behavior,
interests, or activities
PDD-NOS
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JK
PDDs in DSM-IV
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Always associated with MR
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May or may not be associated with MR
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Childhood Disintegrative Disorder or Heller’s syndrome
Rett’s Syndrome
Autism
Pervasive Developmental Disorder - Not Otherwise
Specified (PDD-NOS)
Usually not associated with MR
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Asperger Syndrome (AS)
High Functioning Autism (HFA)
Cognition
75% of people with ASD function in the MR Range
70
 Considerations
 Appropriate test
 Stability of scores
 Scatter is common
 Islets of ability
 "autistic savants”
 Improvement with
early intervention
60
50
40
30
20
10
0
<20 20- 30- 40- 50- 60- 70- 80- 90- 100-110-120+
Full Scale IQ Score
Savant Abilities or Splinter Skills
Drawing: Nadia, Age 3
Drawing
Stephen Wiltshire
Musical Ability
Blind Tom
Calculation
Calendar
Mathematics
Etiology of Autism
 Early focus on parents
Psychodynamic views, Kanner, Bettleheim
 BUT evidence against
No abnormalities in child care
No major personality problems
No obvious deficits in parenting
 By 1970's a large body of evidence favoring
neurobiological etiology
Prevalence
• Used to be thought rare
• Current estimates:
•Autism: 1/1000 - 2/10,000
•Is the frequency of autism increasing?
•Rett=s and CDD very rare - ? 1/15,000
•Asperger=s - ? 1/7,000
•PDD-NOS - ? 1/200
Is the incidence increasing?
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No question that more cases are being
identified but is there a ‘real’ increase?
Changes in definition
Better diagnosis at both ‘ends’ of the spectrum
Growing awareness of the condition
Educational implications of label (for services)
Diagnostic substitution
Do vaccines cause autism?
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Several large, international epidemiological
studies refute association
children get vaccines at 18 mo.; ASD often becomes
obvious at this age
Autism rates in Japan continued to rise after the
withdrawal of MMR vaccine.
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Honda et al. No effect of MMR withdrawal on the incidence of autism: a total
population study. Journal of Child Psychology and Psychiatry 2005
Mercury additives said to be cause were removed BEFORE
increases in prevalence were seen
Children should be vaccinated; danger of not vaccinating is
greater than dangers of inoculation.
Genetics of Autism
•Early impression - no genetics
•But condition rare, cases don=t usually
reproduce
•Subsequent research:
risk in identical twins
rate in sibs (2%)
associated problems in sibs
Functional Classification
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High Functioning
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Includes HFA, AS, and PDD-NOS
IQ within or near normal range
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but adaptive behavior much lower
Fluent, functional language by age 6
Low Functioning
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Includes Autism, PDD-NOS, Rett syndrome, CDD
IQ and adaptive behavior significantly low (<70)
No speech, or small single word/sign vocabulary with a few
phrases, mostly rote or echolalic
Developmental Changes
•Preschool: most "classic" autistic features
•Sometimes not all features are exhibited until age 3
•Some children respond dramatically to intervention
•School age: social interest & behavior problems
•Adolescence:
•gains & losses, seizures onset
•Adulthood:
•About 1/3rd have some degree of independence
•Many individuals require high levels of support
Predictors of Outcome in Autism
• Presence of communicative speech by age 6
• Outcome worse if child is mute or has speech which
is not really used for communication
• Nonverbal IQ in the normal range
• Less classic cases (PDD-NOS) = better outcome
• Seizures are more common with lower IQ
Outcomes in autism
• 1-2% of cases achieve normal outcome
•Live independently and hold down job
• 1/3 have some degree of independence
• 2/3 require high levels of support
• Reports of cures should be viewed with caution
• BUT Future outcomes may improve due to
• Earlier detection
• Better and more sustained intervention
• Mandates for service
Adult Outcome: 1981 vs. 1994
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Limitations of available
data
DeMyer, et al., 1981
Goode, Rutter, &
Howlin, 1994
70
60
50
40
1981
30
1994
20
10
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Good Fair
Poor
Autism: Shades of Difference Video
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http://abcnews.go.com/Video/playerIndex?id=2
286327
http://www.autismspeaks.org/video/glossary.p
hp