Transcript They’re Adults – Why Consider an Autistic Disorder Now?

They’re Already Adults…Why
Consider An Autistic Disorder Now?
Does it Make a Difference, Does it
Really Help?
Terese Pawletko, Ph.D.
Licensed Psychologist/Certified School Psychologist
AER 2010 – Little Rock, Arkansas
As a result of this presentation the attendees will…
• Be able to identify the key features of autism
spectrum disorders (ASD) and diagnostic
considerations
• Come to appreciate the benefit of getting a
diagnosis from the perspective parents of adults
diagnosed with ASD
• Be able to identify areas of function and the links
to intervention
Why important to begin to understand?
• Recent CDC estimates (2009) of the
prevalence of autistic disorders are 1 in 110
Is this a new epidemic or have there always
been children and adults with ASD?
Attendees at workshops …
“I shudder to think of the students I’ve had that
likely were on the autism spectrum – I wish I had
this information then and could have intervened
differently!” suggesting there have always been
some children warranting a dual diagnosis (see
Chess, 1972; Gense, 1994).
Implications of these missed diagnoses?
• Adults in vocational rehabilitation and rehabilitation
teaching systems may be undiagnosed and/or
lacked the benefit of interventions matching their
particular learning style (evidence: families and
professionals raised issues in discussions on the
AER- and other Listserves over the past couple of
years
What diagnoses fall under
the umbrella of autism
spectrum disorders?
Pervasive Developmental Disorders
DSM IV/Autism Spectrum Disorders
Autism
Asperger’s
Syndrome
Childhood Disintegrative
Disorder
Pervasive
Developmental
Disorder NOS
Rett’s Disorder
Autism/ASD is a behaviorally defined
syndrome…
• Diagnosed by presence of various behaviors
• Syndrome – cluster of behaviors
• Not etiology specific though biologically
based: represents developmental
dysfunction in CNS within areas
responsible for social & communication
development (Gillberg, 1989; Volkmar &
Cohen, 1988), other areas of brain re:
regulation, integration, etc.
Terese Pawletko, Ph.D.@2010
What do they (autism, Asperger’s
Syndrome, pervasive developmental
disorder) have in common?
Common Features across the Spectrum*
• Impairments in social interaction
• Impairments in communication
• Impairments in imaginative play; stereotyped
behaviors (e.g., repetitive motor mannerisms);
restricted range of interest, activities
* DSM-IV TR is under revision…
A Practical Definition of Asperger
Syndrome (adapted from Bolick, 2002)
• Awkwardness in communication, despite strong
vocabulary and grammar (e.g., literal, pedantic;
problems with nonverbal communication (including
vocal quality)
• Difficulty “reading” behavior and intent of others
• Difficulty with reciprocal conversation; may be
perseverative, bothersome, nonselective re: place/
time/person with whom discuss topic
• Preference for predictability
• Tendency toward specific and intense interests
Terese Pawletko, Ph.D.@2010
• May have challenges:
– integrating sensory information
– regulating anxiety or mood
– perspective taking, negotiating, compromising
– developing and maintaining social
relationships; occupational functioning
– in executive functioning (e.g., directing
attention, shifting attention; monitoring
performance; organizing approach, organizing
materials; inhibiting response)
Terese Pawletko, Ph.D.@2010
Additionally/currently…
No clinically significant general delay in language
(single words used by age 2 years, communicative
phrases used by age 3 years).
No clinically significant delay in cognitive
development or in the development of ageappropriate self-help skills, adaptive behavior
(other than in social interaction), and curiosity
about the environment in childhood.
Terese Pawletko, Ph.D. @2010
Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)
• Referred to as atypical autism - used when a
child does not meet the criteria for autism or
Asperger’s and yet there is a severe and
pervasive impairment in specified behaviors
ASD are spectrum disorders in the fullest sense of the word…
Social,
communication
Sensory
Sensitivities
Cognitive
Play
Autism Spectrum Disorders
Receptive
Language
(Autism, PDD/NOS,
Asperger’s)
Motor
Executive Functioning (e.g.,
attention, organization,
regulatory)
Expressive
Language
Terese Pawletko, Ph.D.@2008
Picture of a healthy
brain with areas
involved in ASD
curingoxygen.com
Brain_Autism.png
“To diagnose or not to
diagnose, that is the
question…”
Why get the diagnosis?
“How can we throw another label at the
parents, especially when it is the BIG A?”
They already get services under visual
impairment…
Terese Pawletko, Ph.D.@2010
Adult on a list serve for blind/autistic adults
explains…
“The Asperger’s causes me many more problems
across a wide spectrum which blindness does
not do and it has ever since I was a small child.
The symptoms of both autism and depression
have been devastating throughout. When I
was growing up, my tantrums from sensory
over stimulation were attributed to being a
spoiled child and I was treated as such leaving
me with a sense of inferiority and
hopelessness…”
Terese Pawletko, Ph.D. @2010
Different needs…
Different assumptions…
Different orientation…
Different approaches…
Keep the iceberg in mind!!
Monologue vs. conversation
(Difficulties with persp. taking,
shifting attention, flexible use of
language)
What are you seeing
Holds ears when hears people
talking (Difficulties regulating
sensory input)
Avoids eye contact (may have
difficulty with facial complexity
or with looking and listening)
Why might you be seeing it?
No pretend play (literal
interpretation, diff. w/persp tkg)
Tantrums with change (relies on
routine for stability,
predictability; LITERAL)
Terese Pawletko, Ph.D.@2010
The why is beneath the surface…and is
important to understand…
Keep the iceberg in mind!!
Not a ‘team player,’ can’t take
constructive criticism
(Difficulties with persp. taking,
egocentric/rigid/unilateral literal
view of task or situation)
What are you seeing
Critical of co-workers’ behavior
(Rigid interpretation of rules,
work standards – e.g., 10 min.
break means 10 minutes, not
10.5)
Why might you be seeing it?
The why is beneath the surface…and is
important to understand…
Terese Pawletko, Ph.D.@2010
Keep the iceberg in mind!!
Corrects boss, not ‘respect’ the
‘chain of command’ (literal,
egocentric view of word or task;
may assume boss has to ‘earn’
the client’s respect by being
‘true to his/her word;’ may not
tolerate/understand flexible
interpretation of statements
made by boss; corrects spelling,
etc.)
Excellent attention to detail,
works beyond ‘quitting time’ to
finish a job; fabulous Braille
proofreader (literal;
understands ‘the code’ at the
surface level; ‘finishing job’
means ‘finishing,’ may take
longer due to literal
interpretation of standards)
Terese Pawletko, Ph.D.@2010
What are you seeing
Why might you be seeing it?
The why is beneath the surface…and is
important to understand…
Realities/Case Studies…
•
•
•
•
Matthew (ROP, LD, anxiety, explosive disorder)
Katie (SOD/ONH)
Christopher (ROP, LD)
Elise (anophthalmia)
Contact information:
Terese Pawletko, Ph.D.
22 Wildlife Drive, Eliot, Maine 03903
Ph: (603) 396-1645
Email: [email protected]
Any reproduction of any portion of these materials
must provide documentation of their source.
Failure to do so violates copyright (2010). Thank
you.