Transcript AUTISM SPECTRUM DISORDERS Sue Mondak, M.A., CCC-SLP PREVALENCE OF ASD       Prior to 1990’s: 4-5 per 10,000 for autism 2003 California study: Doubling in last 4 years CDC.

AUTISM SPECTRUM
DISORDERS
Sue Mondak, M.A., CCC-SLP
PREVALENCE OF ASD






Prior to 1990’s: 4-5 per 10,000 for
autism
2003 California study: Doubling in last 4
years
CDC 2007: 1 in 150
CDC 2009: 1 in 110
CDC 2012: 1 in 88
CDC 2012: 1 in 54 boys
PREVALENCE (con’t)


More children will be diagnosed with
autism this year than with AIDS,
diabetes, or cancer combined.
Autism is the fastest growing
developmental disorder in the United
States.
DEFINITION - Educational

A brain development disorder
characterized by impairments in social
interaction, communication, and
restricted and repetitive behavior,
typically appearing during the first three
years of life.
DEFINITION – CENTERS FOR
DISEASE CONTROL (CDC)


Autism Spectrum Disorders are a group
of developmental disabilities that can
cause significant social, communication,
and behavioral challenges.
Symptoms can range from mild to
severe.
DEFINITION - DSM-IV



Qualitative impairments in social
interaction
Qualitative impairments in
communication
Restricted repetitive and stereotyped
patterns of behavior, interests, and
activities
DEFINITION (con’t)

Delays or abnormal functioning in at
least one of the following areas, with
onset prior to age 3:



Social Interaction
Language as used in social communication
Symbolic or imaginative play
ASPERGER SYNDROME
DSM-IV



Qualitative impairments in social
interaction
Restricted repetitive and stereotyped
patterns of behavior, interests, and
activities
Clinically significant impairments in
social, occupational, or other important
areas of functioning
ASPERGER SYNDROM (con’t)


No clinically significant general delay in
language
No clinically significant delay in
cognitive development or in the
development of age appropriate self
help skills, adaptive behavior (other
than social interaction) and curiosity
about the environment in childhood
PROPOSED REVISION FOR
DSM - V



Rett’s disorder removed from autism
category
All pervasive developmental disorders
will be called Autism Spectrum Disorder
Minor changes to criteria
CAUSES OF AUTISM



No one knows exactly why, but the
brain develops differently in people with
autism.
It is now widely accepted by scientists
that a predisposition to autism is
inherited.
It is likely that both genetics and
environment play a role.
GENETICS



Researchers have identified a number
of genes associated with ASD.
Identical twin studies show that when
one twin is affected there is up to 90%
chance the other twin will be affected.
In families with one child with ASD, the
risk of having a second child with the
disorder is approximately 5%.
ENVIRONMENTAL FACTORS

A number of pre or post-natal environmental
factors have been claimed to contribute to
ASD or exacerbate it’s symptoms with little
evidence to support these claims





Certain foods (Glutton free diets)
Infectious disease
Heavy metals (Detox methods)
Solvents
Diesel exhaust
ENVIRONMENTAL FACTORS
(con’t)








PCB’s
Phthalates & phenols used in plastic products
Pesticides
Alcohol
Smoking
Illicit drugs
Vitamin deficiencies (Supplements)
Vaccines

A recent Danish study found that
pregnant women who had the flu were
2x more likely to have a child with
autism
EARLY WARNING SIGNS:




No big smiles or other warm, joyful
expressions by 6 months of age or after
No back and forth sharing of sounds, smiles,
or other facial expressions by 9 months of
age
No babbling by 12 months of age
No back and forth gestures such as pointing,
showing, reaching, or waving by 12 months
of age
WARNING SIGNS (con’t)




Lack of eye contact and response to
name
No words by 16 months of age
No meaningful two word phrases (not
including imitating or repeating) by 2
years of age
Any loss of speech, babbling, or social
skills at any age
SOCIAL RECIPROCITY

Definition: The ability to initiate and
respond in social interactions
SOCIAL RECIPROCITY IN
CHILDREN WITH AUTISM






Less frequent spontaneous bids for
communication
Fewer back and forth turns in interaction
Fewer gestures
Inability to recognize communication
breakdowns
More reliance on structured situations for
conversation
More passive conversational style
SOCIAL RECIPROCITY IN OLDER
CHILDREN WITH AUTISM



Difficulty maintaining conversations with
relevant remarks, questions, or
comments
Difficulty providing necessary
background information for
conversations
Difficulty engaging in conversations
appropriate to social context or
interests of others
NONVERBAL COMMUNICATION
IN YOUNG CHILDREN WITH ASD




Limited range of conventional gestures and
vocalizations
Reliance on contact gestures such as hand
leading, pulling, or physical manipulation
Delayed or absent conventional gestures or
distal gestures (pointing)
Use of problem behaviors to communicate
(frequent tantrums)
NONVERBAL COMMUNICATION
IN OLDER CHILDREN WITH ASD



Literal understanding and use of verbal
communication
Limited understanding of sarcasm and
nonliteral language
Monotone speech or atypical prosody
SYMBOLIC PLAY



Limited functional use of objects with
younger children
Repetitive or rigid play
Limited ability to represent objects
when younger and social situations
when older
VERBAL COMMUNICATION IN
CHILDREN WITH ASD



Reliance on immediate or delayed
echolalia
Reliance on rote memory rather than
semantic understanding for longer
utterances
Persistent difficulty with comprehension
VERBAL COMMUNICATION
(con’t)



Difficulty generalizing meaning of words
beyond contexts in which they were
learned
Difficulty learning words other than
nouns at early stages
Difficulties with phonology or motor
planning for speech
LITERACY SKILLS




Difficulty observing or imitating
functional use of books
Limited understanding or use of story
grammar
Poor reading comprehension
Hyperlexia
SENSORY DIFFICULTIES


Difficulty processing sensory input
Senses may be hyper-sensitive or hyposensitive; usually a combination







Tastes
Smells
Touch
Sounds
Sights
Movement and Balance
Body Position/Muscle Control
SENSORY REGULATION

Use of immature or atypical self-regulation
strategies







Chewing on clothing
Carrying objects
Vocal play
Rocking
Visual Stimulation
Covering ears / or dropping objects to hear the
sound
Smelling toys or other objects frequently
ASSESSMENT


Primary assessment is through
observation of communication, behavior
and social interaction
Parental input and developmental
history are essential components of the
evaluation
ASSESSMENT (con’t)

Screening tool:



M-CHAT (doctors often complete in office)
Used to identify children at risk, not to
determine diagnosis
Child who fails 3 total items or 2 critical
items (2,7,9,13,14,15) fail the M-CHAT
ASSESSMENT (con’t)

ADOS: Autism Diagnostic Observation
Schedule

A semi-structured, standardized
assessment of communication, social
interaction, and play or imaginative use of
materials
DIAGNOSIS


May obtain a medical diagnosis from
child Psychiatrist, or behavioral
pediatrician
Educationally: must meet eligibility
qualifications
EDUCATIONAL ELIGIBILITY

See Michigan’s Definition of Autism
Spectrum Disorder Handout
INTERVENTION STRATAGIES



Visual Schedules
Picture Exchange System (PECS)
Sensory Integration Therapy (OT’s)
INTENSIVE INTERVENTIONS


Behavioral / ABA (Applied Behavior
Analysis)
Developmental



Greenspan/Weider DIR/Floortime
6 Functional Developmental Levels
Combined

Denver Early Start Model
DIR Framework
(Greenspan/Weider)






Developmental, Individual differences
and Relationship based
One-on-one intensive engagement
Child centered-’meet them where
they’re at’
DIR is the theory, “Floortime” the
practice
15-25 hour/week beside school
6 Functional developmental levels
6 FUNCTIONAL DEVELOPMENTAL
LEVELS






Self regulation and shared
attention(FDL1)
Engagement (FDL 2)
Two-way Communication (FDL 3)
Complex two-way Communication (FDL
4)
Shared Meanings & Symbolic Play (FDL
5)
Emotional Thinking (FDL 6)
P.L.A.Y. Project Model
Play and Language for Autistic
Youngsters






Developed by Dr. Richard Solomon from the
University of Michigan in 2000
Based on Greenspan’s Floortime/D.I.R. Model
Developed due to no intensive services
publicly in Michigan
Community based, family centered, cost
effective
Now in 27 states and 9 countries
Attempting to bring this to our area
P.L.A.Y. Project Values






Family and child centered
Interventions often in the natural
environment of the home
Parent empowerment model
Relationship based
Playful and fun
Addresses the core deficit: Social
Impairment
DEVELOPMENTAL METHODS AND
OUTCOMES OF THE PROJECT







Contingent, reciprocal, social interactions
Follow the child’s lead, interests, and/or
intent
Shared social attention
Joyful relating
Simple and complex nonverbal gestures
Long interactive sequences of spontaneous
verbal communication
Symbolic language related to affect
P.L.A.Y. Home Consultation



Monthly half day visits
Coach, model, and support parents to
Play
Video/written feedback
GOAL:


To move the child out of their Comfort
Zone, into interactional engagements
with others
To move the child from their current
functional developmental level to the
highest functional developmental level
possible
COMFORT ZONE




What the child does when you let them do
whatever they want to do
Focused on repetitive interests
Tuned out; “In their own world”
Examples:




Lining up toys
Visually self stimming on wheels, lines, objects
Obsessed with numbers and letters
Stuck on same topic: planets, Pokemon
ACTIVITIES FOR FUNCTIONAL
DEVELOPMENTAL LEVELS 1 & 2






Rolling child up in a rug
Swinging in a blanket
Tickling
Gentle wrestling
Playing peek-a-boo
Sensory Motor level
ACTIVITIES FOR FUNCTIONAL
DEVELOPMENTAL LEVELS 3 & 4





Chase: “I’m gonna get you”
Get the bubbles, balloon, etc.
Ball play (rolling it back and forth)
Very simple pretend play: phone to ear,
cars crash
Being silly
ACTIVITIES FOR FUNCTIONAL
DEVELOPMENTAL LEVELS 5 & 6




Pretend play: Dress up, tea party
Real Hide-n-Seek (not just peek-a-boo)
Reading books – looking at pictures and
a telling a simple story
Duck, duck, goose
RESEARCH




The P.L.A.Y. Project is a form of Intensive
Developmental Intervention (IDI)
Studies have found that Intensive
Interventions that incorporate parent training,
and focus on the core deficit of ASD (social
impairment) show significant improvement in
children with autism
Demonstrated improvements in parents skill
in interaction and child functional
development
EEG brain scans confirm improvements