Transcript Autism Asperger’s & Abbie Solish

Autism
&
Asperger’s
Abbie Solish
PhD Candidate
Clinical-Developmental Area
York University
Pervasive Developmental Disorders
(PDD)
Childhood
Disintegrative
Disorder
Autistic
Disorder
PDD-NOS
Asperger’s
Disorder
Rett’s
Disorder
Autistic Disorder (DSM-IV)
(1) Qualitative Impairment in Reciprocal
Social Interaction:
a) impaired nonverbals
b) poor peer relationships
c) lack of spontaneous social sharing
d) lack of social/emotional reciprocity
(must have 2 or more of 4)
Autistic Disorder (DSM-IV)
(2) Qualitative Impairment in
Communication:
a) delayed/absent speech
b) impaired conversational skills
c) stereotyped, repetitive language
d) lack of pretend and social play
(must have 1 or more of 4)
Autistic Disorder (DSM-IV)
(3) Restricted, Repetitive, & Stereotyped
Patterns of Behaviour, Interests, &
Activities:
a) preoccupations, narrow interests
b) adherence to routine, ritual
c) stereotyped behaviour
d) preoccupation with parts of objects
(must have 1 or more of 4)
Ben Loves Trains
Ben is 2.5 and he loves trains. He is content to play
with them alone for hours. Yet he doesn’t seem to
really understand that they are trains. He doesn’t
pretend to make them go on the track or have
crashes or imagine what the cars are carrying or talk,
as he plays alone. He just lines them up in the same
way every time. He gets very upset if anyone
rearranges his trains. Sometimes he carries a train
around with him and rubs it against his chin or waves
it in front of his eyes. He never brings a train to show
his father, never points to the trains to show his
sister. In fact, he completely ignores his sister. Ben
doesn’t talk at all, rarely looks at other people and
rarely smiles…
Early Behaviours in Autism:
What these children often do
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Avoid eye contact
Avoid others, appear aloof
Use toys in repetitive, non-functional ways
Focus on parts of objects
Tantrums/problem behaviours
Odd speech (if any)
Instrumental communication
Autistic leading
Stereotypies (e.g., flapping hands)
Know familiar people
Early Behaviours in Autism:
What these children often don’t do
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Make eye contact
Imitate
Pretend play
Joint attention gestures (e.g., eye gaze,
pointing)
Social interest and social play
Use language to comment
Use language for social purposes
Theory of mind
Early ‘Red Flags’
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no babbling 12 months
no pointing, other gestures 12 months
no single words 16 months
no spontaneous 2-word phrases 24 months
any loss of language or other skills at any age
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With younger children the absence of
typical behaviour is more diagnostic than
presence of atypical behaviour
Early Diagnosis
If ‘red flags’ are present, specific autism
diagnostic tools are used
 A diagnosis should incorporate information
from various sources
 A reliable & valid diagnosis can be made by
age 2 by an expert clinician
 Likely trend towards overdiagnosis in young
delayed children and trend towards
underdiagnosis in high-functioning children
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Prevalence (best estimates)
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Autistic Disorder  10 per 10,000
PDD-NOS
 Asperger’s
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Total
 15 per 10,000
 2.5 per 10,000
 27.5 per 10,000 (1 per ~350)
Ratio  4:1 Males:Females
Is Autism Increasing?
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It depends…
Prevalence vs. Incidence
 Prevalence = % of people in the
population who have the disorder
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• Definitely increasing
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Incidence = # of new cases per unit
of time
• Debatable, no good evidence of increase
Why does is seem like autism is
“increasing”?
The diagnostic criteria have
broadened and changed
 Much better now at early diagnosis
 Low functioning children can now get
a diagnosis of autism rather than just
MR
 At the high end of the spectrum
there is more recognition of the
broader phenotype
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Who has autism?
No relationship to SES
 No relationship to immigrant status
 No relationship to race or ethnicity
 No environmental causes/clusters
 Some evidence of genetic
concordance
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What “causes” autism?
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A specific cause has not been yet been identified
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Current investigations specific to autism include:
– birth and pregnancy problems
– problems in specific areas of brain
– brain chemicals (neurotransmitters)
– brain infections
– genetics
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One single cause cannot account for everything/all
subtypes of PDD
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We do know that it is NOT parents
Is there a “cure”?...
New & Alternative Treatments
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Auditory Training
Sensory Integration
Vitamins/Food Supplements
Special Diets/Food Allergies, Sensitivities
Physical Exercise
Holding Therapy
Deep Pressure
Facilitated Communication
Miller Method
Irlen Lenses
Patterning
Gentle Teaching
Swimming with Dolphins
Secretin
Centrifugal Therapy
…
New & Alternative Treatments
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The problem is that most of these
treatments are not supported by any
research
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Many parents believe in “miracle” or
“breakthrough” “cures”
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Gives them hope
Feel less helpless
Danger in not accepting the child as he/she is
Expensive
Intensive Behavioural Intervention
(IBI)
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“Intensive” (often 20-40 hrs/wk for 1-2
yrs.)
Begin early (usually before 4)
Schedule is highly structured
and predictable
Program is individualized
Specific teaching methods vary
Include complex variety of techniques to
promote independence and generalization
2 Dimensions of Severity
Autistic Symptom Severity
Autistic
Disorder
PDD-NOS
Asperger’s
Disorder
Severity of Intellectual Disability
Profound Severe Moderate Mild Borderline Average Superior
Carolyn Just Wants
to Be Friends
Carolyn is 12 and is great at puzzles. She can do them
just as fast whether they are picture side up or upside
down! She struggles with her school work, especially
language arts and social studies, but is pretty good at
spelling and math and has an excellent memory. She
was in special education classes when she was younger,
but is now in a regular class. She seems very friendly
and talkative, though a bit immature. She goes up and
asks questions of anyone she comes in contact with,
even if they’re not interested in talking to her. She
doesn’t know how to relate to other kids very well but
really wants to be friends. She is enrolled in a social
skills group at a local treatment agency. Her mother
worries about what is in store for Carolyn as a
teenager and adult…
Asperger’s Disorder (DSM-IV)
A. Qualitative Impairment in Reciprocal
Social Interaction:
a) impaired nonverbals
b) poor peer relationships
c) lack of spontaneous social sharing
d) lack of social/emotional
reciprocity
(must have 2 or more of 4)
Asperger’s Disorder (DSM-IV)
B. Restricted, Repetitive, and
Stereotyped Patterns of Behaviour,
Interests, and Activities:
a) preoccupations, narrow interests
b) adherence to routine, ritual
c) stereotyped behaviour
d) preoccupation with parts of objects
(must have 1 or more of 4 criteria)
Asperger’s Disorder (DSM-IV)
C. Clinically significant impairment in
social, occupational functioning
D. No clinically significant language
delay
E. No clinically significant cognitive
delay, adaptive behaviour
Prevalence
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Prevalence ranges:
– 3-4 in every 1000 children develop the full
clinical picture of AS
– 2.5 per 10,000
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Why is there such a range?
– No consistent diagnostic criteria for AS
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6:1 Male to Female ratio
– Actual ratio is believed to be closer to 4:1
Other difficulties associated
with Asperger’s
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IQ profile
Communication problems affecting speech and
language
– Language “oddities”:
• Hyperlexia
• Literal use and understanding of language
• Pragmatic difficulties
• Flat prosody
Perceptual problems
 Motor control problems
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Comorbidity
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ADHD
Tics and Tourette Syndrome
Anxiety
– Social anxiety
– OCD
Conduct disorder
Eating disorders
Mood Disorders
– Depression (most common secondary diagnosis)
– Bipolar
– Suicidal ideation
Alcohol and Drug abuse
Schizophrenia & isolated psychotic episodes
Interventions for Asperger’s
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Not one specific empirically validated
treatment (like IBI for Autism)
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Social skill groups
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School interventions
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Medications
– often used to treat comorbid conditions
– have to watch for atypical reactions to
the drugs
• e.g., SSRIs, Neuroleptic, Stimulants, Anti-epileptic
drugs, Lithium
Summary
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Autism and Asperger’s are two of the Pervasive
Developmental Disorders
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Children with Autism must show impairments in social
and communication abilities as well as have behavioural
concerns to receive a diagnosis
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Children with Asperger’s must show impairments in their
social abilities and specific behavioural concerns, but do
not show language impairments like children with Autism
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The prevalence of Autism/Asperger’s is increasing,
although perhaps not the incidence
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The “cause” of Autism/Asperger’s is still unknown
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There is currently no “cure” for Autism or for
Asperger’s
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IBI is the current intervention of choice for children
with Autism