1. AUTISM

2. Overview What is Autism? Is there more than one type of Autism?
What causes Autism?
How is Autism diagnosed?
What are the characteristics of Autism?
What are the most effective approaches to treating Autism? Is there a cure?

3. WHAT IS AUTISM? Very complex, often baffling developmental disability
First described by Leo Kanner in 1943 as early infantile autism
“Auto” – children are “locked within themselves.”
For next 30 years, considered to be an emotional disturbance

4. WHAT IS AUTISM?
Today, autism is a severe form of a broader group of disorders
These are referred to as pervasive developmental disorders
Typically appears during the first 3 years of life

5. WHAT IS AUTISM?
Very likely neurological in origin – not emotional, not the refrigerator mom
Prevalence figures vary widely earlier: 5/10,000, but recent data say as high as 1/1000 or even 1/500.
4 times more prevalent in boys
No known racial, ethnic, or social boundaries
No relation to family income, lifestyle

6. WHAT IS AUTISM?
Autism impacts normal development of the brain in areas of social interaction and communication skills.
Difficult to communicate with others and relate to the outside world.
Occasionally, aggressive and/or self-injurious behavior may be present.

7. WHAT IS AUTISM?
May exhibit repeated body movements (hand flapping, rocking).
Unusual responses to people
Attachment to objects
Resistance to change in routine
Sensory sensitivities

8. WHAT ARE THE TYPES?
Actually, the “umbrella” heading is Pervasive Developmental Disorder (PDD).
Autism is one of the 5 PDDs.
All have commonalities in communication and social deficits
Differ in terms of severity

10. 1. Autistic Disorder
Impairments in social interaction, communication, and imaginative play.
Apparent before age 3.
Also includes stereotyped behaviors, interests, and activities

11. 2. Asperger’s Disorder
Impairments in social interactions, and presence of restricted interests and activities
No clinically significant general delay in language
Average to above average intelligence

12. 3. Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)
Often referred to as atypical autism
Used when a child does not meet the criteria for a specific diagnosis, but there is severe and pervasive impairment in specified behaviors

13. 4. Rett’s Disorder
Progressive disorder which, to date, has only occurred in girls.
Period of normal development and then the loss of previously acquired skills
Also loss of purposeful use of hands, which is replaced by repetitive hand movements
Beginning at age of 1-4 years

14. 5. Childhood Disintegrative Disorder
Normal development for at least the first 2 years
Then significant loss of previously acquired skills

15. Conclusions on Types Autism is a spectrum disorder
This means that symptoms and characteristics can present themselves in wide variety of combinations, from mild to severe
Autistic individuals can be very different from each other
“Autism” is still commonly used to refer to any of the 5 PDDs

16. What causes (and doesn’t cause) autism?
Good agreement in general that autism is caused by abnormalities in brain development, neurochemistry and genetic factors
Some of the research indicates a variety of things including: Exposure to heavy metals Environmental issues Lyme Disease, etc.
Yet there is no proof that any one of these areas is truly responsible for Autism.
Another scenario is that there have always been many children with Autism, but the diagnosis hasn't been there like it is now.
Bettlelheim’s theory of psychogenesis?

17. How is Autism Diagnosed?
No definitive medical test
Team uses interviews, observation, and specific checklists developed for this purpose.
Team might include neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, etc.
Must rule out MR, hearing impairment, behavior disorders, or eccentric habits

18. CHARACTERISTICS 1. Communication/Language 2. Social Interaction
3. Behaviors
4. Sensory and movement disorders
5. Resistance to change (predictability)
6. Intellectual functioning

19. 1. Communication/language
Broad range of abilities, from no verbal communication to quite complex skills
Two common impairments:
A. Delayed language
B. Echolalia

20. A. Delayed language
50% of autistic individuals will eventually have useful speech (?)
Pronoun reversal: “You want white icing on chocolate cake.”
Difficulty in conversing easily with others
Difficulty in shifting topics
Look away; poor eye contact
Facilitated communication?

21. Elements of Facilitated Communication
1. Physical Support
2. Initial training/introduction
3. Maintaining focus
4. Avoiding competence testing
5. Generalization
6. Fading

22. B. Echolalia
Involuntary parrot-like repetition (echoing) of a word or phrase just spoken by another person.
Common in very young children (Age 3)
Immediate or delayed
Is there communicative intent with echolalia?

23. 2. Social Interaction
One of hallmarks of autism is lack of social interaction
1. Impaired use of nonverbal behavior
2. Lack of peer relationships
3. Failure to spontaneously share enjoyment, interests, etc. with others
4. Lack of reciprocity
Theory of mind?

24. 3. Behaviors
Repetitive behaviors, including obsessions, tics, and perseveration
Impeding behaviors (impede their learning or the learning of others)
Will need positive behavior supports
A. Self-injurious behavior
B. Aggression

25. 4. Sensory and movement disorders
Very common
Over- or under-sensitive to sensory stimuli
Abnormal posture and movements of the face, head, trunk, and limbs
Abnormal eye movements
Repeated gestures and mannerisms
Movement disorders can be detected very early – perhaps at birth

26. 5. Predictability Change in routine is very stressful
May insist on particular furniture arrangement, food at meals, TV shows
Symmetry is often important
Interventions need to focus on preparing students for change if possible

27. 6. Intellectual functioning
Autism occurs in children of all levels of intelligence, from those who are gifted to those who have mental retardation
In general, majority of individuals with autism are also identified as having mental retardation – 75% below 70
Verbal and reasoning skills are difficult
Savant syndrome

28. Interventions 1. Individualization and early intervention are the keys
2. Include life skills, functional academics, and vocational preparation
3. Positive behavior support
4. Social stories (music therapy?)
5. *Lovaas model
*Behavioral intervention program developed in the Psychology Department of UCLA under the direction of Dr. O. Ivar Lovaas.

30. 1 to 1.5 million Americans <2>
Facts and Statistics
1 in 150 births <1> Only 20 years ago the statistics were 1 in 10,000.
4:1 ratio of boys to girls
1 in 98 boys
1 to 1.5 million Americans <2>
Fastest-growing developmental disability % annual growth
$90 billion annual cost <3>
90% of costs are in adult services <3>
Cost lifelong care can be reduced by 2/3 w/ early diagnosis/intervention <3>
In 10 years, the annual cost will be $ billion <4>
1.Based on prevalence statistics from the Centers for Disease Control and Prevention (2007).
2.Based on the autism prevalence rate of 2 to 6 per 1,000 (Centers for Disease Control and Prevention, 2001) and 2000 U.S. Census figure of 280 million Americans.
3.Jarbrink K, Knapp M, 2001, London School of Economics study: "The economic impact on autism in Britain," 5 (1): 7-22.
4.ASA calculates that the annual cost of autism will increase to $ billion in 10 years. February 2003
There are more than 500,000 individuals under the age of 21 with some form of Autism right now in the United States.

31. Incidence vs. Private Funding (2007)
Facts and Statistics cont.
More children will be diagnosed with autism this year than cancer, diabetes, Downs Syndrome and AIDS combined.
Autism receives less than 5% of the research funding of most of the more prevalent childhood disorders.
Incidence vs. Private Funding (2007)
Condition Incidence Private Funding Pediatric AIDS 1 in 8, Million Leukemia in 25, Million Muscular Dystrophy 1 in 20, Million Juvenile Diabetes 1 in Million Autism in Million

33. Autism Society of Oregon
Autism Organizations
Oregon:
Autism Society of Oregon
USA:
Asperger and Autism Information by MAAP Services
Autism National Committee (AUTCOM/ANC)
Autism Network International (ANI)
Autism Society of America
Autism Speaks
Center for the Study of Autism
Families for Early Autism Treatment (FEAT) of Northern California
Society for Auditory Integration Training