1. Autism Spectrum Disorders MNU SPED: 7023 Credit: Dr. Katie Cook

2. Autism Prevalence (CDC) 1% or 1 in every 55 children has been diagnosed with autism Including 1 in 70 boys. Staggering 57 percent increase from 2002 to 2006 600 percent increase in the past 20 years Average age of diagnoses is 53 months

3. Autism Clock

4. Autism Spectrum Disorders More common than childhood cancer, juvenile diabetes and pediatric AIDS combined. An estimated 1.5 million individuals in the U.S. and tens of millions worldwide are affected by autism. Government statistics suggest the prevalence rate of autism is increasing 10-17 percent annually. Studies suggest boys are more likely than girls to develop autism and receive the diagnosis three to four times more frequently.

6. Number of Cases

7. Kansas: Number of Cases

8. Missouri: Number of Cases

9. Autism Diagnostic Substitution

10. The previous graph examines the possibility of a diagnostic substitution between mental retardation, developmental delay and autism. The graph illustrates 3 key points: The prevalence of mental retardation does not start to decline until the introduction of the developmental delay category. The developmental delay category was introduced the 1997 school year, which is the 1989 birth cohort on the graph above. For school years 1993 to 1997 there is no decline in mental retardation, while the autism prevalence increases. A diagnostic substitution between mental retardation and developmental delay fits the data better than a diagnostic substitution between mental retardation and autism. If you assume a diagnostic substitution from mental retardation to developmental delay the combined prevalence does not show a significant change from 1993 to 2006 birth cohorts. During the same time period there is a significant increase of autism prevalence. The decline in mental retardation prevalence from years 1993 to 2006 only accounts for 69% of the increase in autism prevalence during the same time period. Autism prevalence increased from 5.48 to 56.23 per 10,000 births, while mental retardation declined from 101.13 to 65.99. Therefore, if there was a diagnostic substitution from mental retardation to autism it could not fully explain the increase in autism prevalence. Information gathered from www.fightingautism.org on June 8 th, 2010www.fightingautism.org

11. What Causes Autism??? The simple answer is we don't know. The vast majority of cases of autism are idiopathic, which means the cause is unknown. The more complex answer is that just as there are different levels of severity and combinations of symptoms in autism, there are probably multiple causes. The best scientific evidence available to us today points toward a potential for various combinations of factors causing autism – multiple genetic components that may cause autism on their own or possibly when combined with exposure to as yet undetermined environmental factors. Timing of exposure during the child's development (before, during or after birth) may also play a role in the development or final presentation of the disorder. A small number of cases can be linked to genetic disorders such as Fragile X, Tuberous Sclerosis, and Angelman's Syndrome, as well as exposure to environmental agents such as infectious ones (maternal rubella or cytomegalovirus) or chemical ones (thalidomide or valproate) during pregnancy. There is a growing interest among researchers about the role of the functions and regulation of the immune system in autism – both within the body and the brain. Piecemeal evidence over the past 30 years suggests that autism may involve inflammation in the central nervous system. There is also emerging evidence from animal studies that illustrates how the immune system can influence behaviors related to autism. While the definitive cause (or causes) of autism is not yet clear, it is clear that it is not caused by bad parenting. Information gathered from Autism Speaks, May 24 th, 2010

12. The Autism Spectrum There is a continuum or spectrum of autistic disorders (ASD) held together by a triad of impairments affecting: social interaction communication and imagination, accompanied by a narrow repetitive pattern of activities.

13. Diagnostic and Statistical Manual of Mental Disorders- 1V Classification System Pervasive Developmental Disorders : 1. Autistic Disorder 2. Childhood Disintegrative Disorder 3. Asperger Disorder 4. Rett’s Disorder 5. Pervasive Developmental Disorder--Not Otherwise Specified

14. Diagnostic Criteria for Autism Diagnostic Criteria for Autistic Disorder A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3) (1) qualitative impairment in social interaction, as manifested by at least two of the following: (a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction (b) failure to develop peer relationships appropriate to developmental level (c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) (d) lack of social or emotional reciprocity (2) qualitative impairments in communication as manifested by at least one of the following: (a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others (c) stereotyped and repetitive use of language or idiosyncratic language (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level (3) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following: (a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (b) apparently inflexible adherence to specific, nonfunctional routines or rituals (c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) (d) persistent preoccupation with parts of objects B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

15. Autistic Disorder Social Interaction Communication Patterns of Behavior Onset Prior to Age 3 Rule Out Rett’s or CDD

16. Characteristics of Children with Autism Communication/Language Language develops slowly or not at all Child uses words without attaching the usual meaning Cognitive <50% of intellectual deficits 2 English studies report rates as low as 26-29% Social Behavior Child tends to spend time alone rather than with others Child is less responsive to social cues such as eye contact or smiles Sensory Issues Child exhibits unusual reactions to physical sensations, such as being overly sensitive to touch or under-responsive to pain Sight hearing, touch, pain, smell, and taste may be affected Play Behavior Child exhibits lack of spontaneous or imaginative play Child does not imitate other’s actions Child does not initiate pretend games Problem Behaviors Child may throw frequent tantrums for NO apparent reason Child may perseverate on a single item, idea, or person Child demonstrates apparent lack of common sense and safety skills Child may show aggressive, violent or self-injuries behavior Arick, Loos, Falco, & Krug 2004

17. Diagnostic Criteria for Asperger’s Disorder DSM-IV DIAGNOSTIC CRITERIA FOR ASPERGER'S DISORDER A.Qualitative impairment in social interaction, as manifested by at least two of the following: (1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction (2) failure to develop peer relationships appropriate to developmental level (3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) (4) lack of social or emotional reciprocitydevelopmental level B.Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: (1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus (2) apparently inflexible adherence to specific, nonfunctional routines or rituals (3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) (4) persistent preoccupation with parts of objects C.The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. D.There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years). E.There is no clinically significant delay in cognitive development or in the development of age- appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. F.Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.Pervasive Developmental Disorder

18. Asperger’s Disorder Social Interaction Patterns of Behavior No significant general language delay No significant cognitive delay Not another PDD or schizophrenia

19. DSM V: Proposed Changes Autism Spectrum Disorder Must meet criteria 1, 2, and 3: 1. Clinically significant, persistent deficits in social communication and interactions, as manifest by all of the following: a. Marked deficits in nonverbal and verbal communication used for social interaction: b. Lack of social reciprocity; c. Failure to develop and maintain peer relationships appropriate to developmental level 2. Restricted, repetitive patterns of behavior, interests, and activities, as manifested by at least TWO of the following: a. Stereotyped motor or verbal behaviors, or unusual sensory behaviors b. Excessive adherence to routines and ritualized patterns of behavior c. Restricted, fixated interests 3. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

20. DSM V: Proposed Changes 299.80 Rett’s: The work group is recommending that this disorder not be included in DSM-5. 299.80 Asperger’s Disorder: The work group is proposing that this disorder be subsumed into an existing disorder: Autistic Disorder (Autism Spectrum Disorder).Autistic Disorder (Autism Spectrum Disorder). 299.10 Childhood Disintegrative Disorder: The work group is proposing that this disorder be subsumed into an existing disorder: Autistic Disorder (Autism Spectrum Disorder).Autistic Disorder (Autism Spectrum Disorder). 299.80 Pervasive Developmental Disorder Not Otherwise Specified: The work group is proposing that this disorder be subsumed into an existing disorder: Autistic Disorder (Autism Spectrum Disorder).Autistic Disorder (Autism Spectrum Disorder). Information gathered from http://www.dsm5.org on May 26 th, 2010http://www.dsm5.org

21. The History of Autism 1911 Swiss psychiatrist Eugen Bleuler first introduced the term autism Swiss Autism and autistic stem from the Greek word "autos," meaning self. The term autism originally referred to a basic disturbance in schizophrenia, in short, an extreme withdrawal of oneself from the fabric of social life, but not excluding oneself.

22. A look at the History of Autism In the early 1900s, psychologist Carl Gustav Jung introduced the well-known personality types, extroverts and introverts Severe introversion was believed to be characteristic of autism and some forms of schizophrenia

23. History of Autism In 1944, American Bruno Bettelheim directed the Chicago-based Ortho-genic School for children with emotional problems, placing special emphasis on the treatment of autism. Bettelheim believed that autistic children had been raised in unstimulating environments during the first few years of their lives, when language and motor skills develop. "refrigerator mother."

24. History of Autism 1943 Leo Kanner published his report while at Johns Hopkins. He conducted a case study of 11 children who appeared to share a number of common characteristics that he suggested formed a "unique 'syndrome' not heretofore reported." He titled the article, "Autistic disturbances of affective contact," and characterized the children as possessing, from the very beginning of life, what he called an "extreme autistic aloneness."

25. History of Autism 1944 Hans Asperger published "Autistic psychopathy in childhood." The article presented a case study of several children whom he described as examples of "a particularly interesting and highly recognizable type of child."

26. Kanner and Asperger They both chose the word autism, a term coined by Bleuler in reference to the aloneness experienced by schizophrenic patients, in order to characterize the nature of the underlying disturbance. The common feature of this disturbance was that the children seemed unable to entertain normal relationships with people.

27. History of Autism 1981 Lorna Wing translates Asperger’s work and adds insight

28. Do Symptoms of Autism Change Over Time? For many children, autism symptoms improve with treatment and with age. Some children with autism grow up to lead normal or near-normal lives. Children whose language skills regress early in life, usually before the age of 3, appear to be at risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with autism may become depressed or experience behavioral problems.

29. How is Autism Treated? There is NO cure for autism. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that target the core symptoms of autism: impaired social interaction, problems with verbal and nonverbal communication, and obsessive or repetitive routines and interests. Most professionals agree that the earlier the intervention, the better. Educational/behavioral interventions : Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills. Family counseling for the parents and siblings of children with autism often helps families cope with the particular challenges of living with an autistic child. Medications : Doctors often prescribe an antidepressant medication to handle symptoms of anxiety, depression, or obsessive-compulsive disorder. Anti-psychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity. Other therapies : There are a number of controversial therapies or interventions available for autistic children, but few, if any, are supported by scientific studies. Parents should use caution before adopting any of these treatments.

30. Need for Early Diagnosis On October 29, 2007, the American Academy of Pediatricians called for screening of all children for autism at 18 and 24 months of age.

31. Early detection plays a significant role in enhancing the developmental outcomes of children with autism (Goin & Myers, 2004).

32. The Value of Early Detection 1. Research indicates that early identification facilitates early intervention – Early intervention is essential for better outcomes Mirenda, P. (2004). Early Childhood Educators of BC Provincial Conference, University of British Columbia

33. The Value of Early Detection Research indicates that intervention provided before age 3 ½ has greater impact than that after age 5 (Fenske, Zalenski, Krantz, & McClannahan, 1985; Harris & Handleman, 2000) Some suggestion that intervention beginning before age 3 may have an even greater impact (McGee, Morrier, and Daly, 1999) The average age for diagnosis in the United States is not until 3-4 years

34. The Value of Early Detection 2. Parents need accurate information so they can access resources and support systems and become educated on Autism Spectrum Disorders (ASD) therefore increasing their ability to make informed decisions

35. Early Identification Firm diagnosis possible by 36 months, with indicators for concern appearing earlier Numerous studies have examined early indicators of ASD from 1st birthday party videotapes, parent surveys, formal test measures Mirenda, P. (2004). Early Childhood Educators of BC Provincial Conference, University of British Columbia

36. Red Flags! Relating with warmth and pleasure Looking at faces and smiling back at others by 4 months No big smiles and joyful expressions by 6 months Back and forth vocalizations and gestures No sharing of sounds, smiles, facial expressions by 9 months No responding to name when called by 12 months No babbling by 12 months No reciprocal gestures (pointing, showing, reaching, waving) by 12 months

37. Red Flags! (Con’t) Problem solving No attempts to recreate or continue interesting displays or events, either motorically or communicatively (e.g., asking for “more” or “help”) Two way communication with words (approximately 25- 30% of child with lose speech between 15-24 months) No words by 16 months No two-word meaningful phrases (without imitating or repeating) by 24 months ANY loss of speech or babbling at ANY age Lack of the development of Joint Attention

38. Other Possible Red Flags! Poor eye contact Play Limited ability to use objects functionally (Doesn't seem to know how to play with toys) Excessively lines up toys or other objects Is attached to one particular toy or object Deficits in symbolic or make-believe play At times seems to be hearing impaired

39. IDEA and ASD The Individuals with Disabilities Education Improvement Act (IDEA ’04) ensures that all children with disabilities have available to them a free appropriate public education (FAPE) that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment and independent living. [34 CFR 300.1(a)] [20 U.S.C. 1400(d)(1)(A)] IDEA ’04 defines Autism as a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. Autism does not apply if a child’s educational performance is adversely affected primarily because the child has an emotional disturbance, as also defined by IDEA ‘04. A child who manifests the characteristics of autism after age three could be identified as having autism if the criteria are satisfied.[34 CFR 300.8(c)(1)(i)-(iii)] [20 U.S.C. 1401 (a)(i-ii)]

40. Educating Children with Autism, 2001. National Research Council Federal Legislation Relevant to ASD IDEA 1. Does the child have a qualifying disability? 2. Does the child need special education services due to the disability? “With Autism” answers the 1 st question…then ALL children with an ASD are entitled to the provisions under IDEA

41. Educating Children with Autism, 2001. National Reseach Council Goals for Educational Services Recommendations 1. Social Skill Instruction 2. Expressive verbal language, receptive language, and nonverbal communication skills 3. Functional communication system 4. Increased engagement and flexibility in tasks/play, ability to attend to the environment and respond to appropriate motivation

42. Educating Children wtih Autism, 2001. National Research Council Goals for Educational Services Recommendations cont. 5. Fine and gross motor skills (functional activities) 6. Cognitive skills including symbolic play and basic concepts 7. Replacement of problem behaviors 8. Independent organizational skills and other behaviors that underlie success in a general education class (completing task independently, following group instructions, asking for help)

43. Educating Children with Autism, 2001. National Research Council Characteristics of Effective Interventions Recommendations Educational services should include a minimum of 25 hours a week, 12 months a year engaged in systematically planned and developmentally appropriate educational activities aimed at goal mastery Receive sufficient individualized attention on a daily basis (individual therapies, developmentally appropriate small group instruction, direct 1:1 contact with teaching staff)

44. Educating Children with Autism, 2001. National Research Council Characteristics of Effective Interventions Recommendations cont. Assessment: lack of documented objective progress over a 3 month period demonstrates need to increase intensity of programming To the extent that it leads to specified goals children should receive specialized instruction in settings in which ongoing interactions occur with typically developing peers

45. Educating Children with Autism, 2001. National Research Council 6 Kinds of Interventions Should Have Priority 1. Functional spontaneous communication 2. Social Instruction 3. Teaching of play skills with peers and appropriate use of toys and materials 4. Goals aimed at cognitive development should be carried out in context in which skill are to be used – generalization/maintenance 5. Problem behavior interventions need to be based on information from an FBA 6. Functional academic skills should be taught when appropriate

46. National Standards Project January 2010 Goal: provide critical information about which treatments have been shown to be effective for students with an ASD 11 “Established” Treatments Antecedent Package Behavioral Package Comprehensive Behavioral Treatment for Young Children Joint Attention Intervention Modeling Naturalistic Teaching Strategies Peer Training Package Pivotal Response Treatment Schedules Self-management Story-Based intervention Package 22 “Emerging” Treatments 5 “Unestablished” Treatments

47. So… Over 50 years of research has led to 4 conclusions: 1. Autism is generally a lifelong condition 2. Autism is a biologically based trauma and is not caused by parents 3. Autism has multiple causes, yet no causes have been scientifically isolated and confirmed 4. Many education and treatment programs are effective – some very effective with certain individuals – and dramatic gains have repeatedly been demonstrated when these quality programs are used (McEachin, Smith, & Lovaas, 1993; Nash, 2002)

48. Resources: The National Professional Development Center on Autism Spectrum Disorders http://autismpdc.fpg.unc.edu/http://autismpdc.fpg.unc.edu/ The National Professional Development Center on Autism Spectrum Disorders is a multi-university center to promote the use of evidence- based practice for children and adolescents with autism spectrum disorders. The Center operates through three sites that include the FPG Child Development Institute at the University of North Carolina at Chapel Hill, the M.I.N.D. Institute at University of California at Davis Medical School, and the Waisman Center at the University of Wisconsin at Madison. Each year, three states are selected through a competitive application process for a two-year partnership with the Professional Development Center. The Center works in coordination with each state’s Department of Education, Part C agency, and University Center for Excellence in Developmental Disabilities to provide professional development to teachers and practitioners who serve individuals from birth through twenty-two years with autism spectrum disorders.

49. The National Professional Development Center on Autism Spectrum Disorders cont. EBP BRIEF COMPONENTS OVERVIEW: A general description of the practice and how it can be used with learners with autism spectrum disorders. STEP-BY-STEP DIRECTIONS FOR IMPLEMENTATION: Explicit step- by-step directions detailing exactly how to implement a practice, based on the research articles identified in the evidence base. IMPLEMENTATION CHECKLIST: The implementation checklist offers a way to document the degree to which practitioners are following the step-by- step directions for implementation, which are based on the research articles identified in the evidence base. EVIDENCE BASE: The list of references that demonstrate that the practice is efficacious and meets the National Professional Development Center’s criteria for being identified as an evidence-based practice. Some practices include supplemental materials such as data collection sheets.

50. The National Professional Development Center on Autism Spectrum Disorders cont Course Content for Foundations of Autism Spectrum Disorders Session 1: Understanding Pervasive Developmental Disorders and ASD Session 2: Characteristics of Individuals with Autism Spectrum Disorders Session 3: Assessment for Autism Spectrum Disorders Session 4: Guiding Principles Session 5: Factors that Affect Learning and Development Session 6: Instructional Strategies and Learning Environments Session 7: Foundations of Communication and Social Interventions Session 8: Promoting Positive Behavior and Reducing Interfering Behaviors

51. National Autism Center http://www.nationalautismcenter.org http://www.nationalautismcenter.org The National Autism Center is one of May Institute's centers for service, training, and research. It is a nonprofit organization dedicated to serving children and adolescents with Autism Spectrum Disorders (ASD) by providing reliable information, promoting best practices, and offering comprehensive resources for families, practitioners, and communities. National Standards Project

52. Resources ASD Video Glossary http://www.autismspeaks.org/video/glossary.php http://www.autismspeaks.org/video/glossary.php Autism Internet Modules (AIM) http://www.autisminternetmodules.org/ http://www.autisminternetmodules.org/ http://www.sharedwork.org/http://www.sharedwork.org/ Autism Spectrum Disorders

53. Remember… You can make a difference

54. REMEMBER…. Educators play a pivotal role…. Stay informed!!!