Presentation on theme: "Autism and Autism Spectrum Disorders"— Presentation transcript:
1 Autism and Autism Spectrum Disorders Professor Graham Martin OAMDirector Child and Adolescent PsychiatryThe University of Queensland
2 AutismA severely disabling condition that develops in first 3 years of lifeOccurs approx 1 in every birthsMore common in boys (4:1)Features vary from child to child, and differ in severity from child to childNo influence from ethnic, racial, social factors, income, lifestyle or parental educational levels
3 Common Features Communication problems Limited Social Interactions Both verbal and non-verbal, with relative lack of speech, repeated words, phrases or patternsLimited Social InteractionsPoor eye contact and difficulty interactingDifficulties expressing emotionsPoor perception of how others think and feelRepetitive Behavioursrepeating words or actionsobsessively following routines
4 Causes of Autism Genetic 12 or more genes on different chromosomes may be involvedGenes maymake a person more susceptible to impact of (say) infectiondirectly cause specific symptomsdetermine severity of symptoms
5 Likely Chromosomes and Genes The X ChromosomeHOXA1HOXD1Gamma-amino-butyric acid (GABA) pathway genesconsensus that it is Polygenetic (>10)
6 Other Causes 24% of cases overlap other genetic medical disorders Fragile X SyndromeTuberous Sclerosis, Phenylketonuria (PKU)Rett SyndromeOther possible causesin utero rubellaencephalopathycytomegalovirus
7 Diagnostic Criteria6 items; at least 2 from (1), 1 each from (2) & (3)(1) Qualitative impairment in social interaction, as manifested by at least two of the following:Marked impairment in the use of multiple non verbal behaviors such as eye- to- eye gaze, facial expression, body postures, and gestures to regulate social interaction.Failure to develop peer relationships appropriate to developmental levelA lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by lack of showing, bringing, or pointing out objects of interest)Lack of social or emotional reciprocity
8 Diagnostic Criteria (2) Qualitative impairments in communication as manifested by at least one of the following: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)In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.Stereotyped and repetitive use of language or idiosyncratic language, or copying of language (Echolalia)Lack of varied, spontaneous make- believe play or social imitative play appropriate to developmental level.
9 Diagnostic Criteria (3) Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.Apparently inflexible adherence to specific, nonfunctional routines or ritualsStereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting or complex whole body movements or copying of movements (Echopraxia)Persistent preoccupation with parts of objects.
10 Diagnostic CriteriaB. Delays or abnormal functioning in at least one of the following areas, with onset prior to age three years:Social interactionLanguage as used in social communication orSymbolic or imaginative playC. Not better accounted for by Rett disorder or childhood disintegrative disorder.
11 Sensory ChangesOverly sensitive to touch (may have a tactile defensiveness)Under-responsive to painSenses may be affected to a lesser or greater degreeNo real fear of dangers
12 Play Lack of social interaction in play - which is more solitary Lack of spontaneous or imaginative playDoes not imitate others’ actionsDoes not initiate pretend gamesSustained odd play
13 Behaviours Overactive or Passive Temper tantrums for no apparent reasonMay perseverate on a single item, idea, personApparent lack of common senseMay show aggression or violent behavioursMay injure themselves deliberately for no apparent reasonMay spin objects, line things up, organizeInappropriate attachment to objectsUnresponsive to normal teaching methodsInsistence on sameness; resists change in routineUneven gross/fine motor skills (may not can kick ball but can stack chairs)
14 Absolute Indications For ASD Assessment No babbling, or pointing, or other gestures by 12 monthsNo single words by 16monthsNo 2-word spontaneous phrases by 24 monthsany loss of any languageany loss of social skills at any age
15 Specific Screen for Autism Full audiological assessment, lead screen if pica presentCHAT, MCHATAutism Screening QAustralian Scale for Asperger’s Syndromethen refer for intervention and autism specific assessment
16 Specific Autism evaluation Diagnostic Parental Interviews Gilliam Autism Rating Scale (GARS)Parent Interview for AutismThe Pervasive Developmental Disorders Screening Test ( PDDST)Autism Diagnostic Interview- Revised (ADI-R)
18 Intervention There is no cure for autism. Treatment and education approaches may reduce some challenges associated with the disability.Intervention may lessen disruptive behaviours.Education can teach self-help skills for greater independence.Intervention needs to be tailored to the individual, and their family
19 Behaviour TherapyMost widely used and successful method is intensive behavioural intervention (IBI)“We believe that behavior modification carried out in systematic, highly individualized, daily programming is the best overall approach now available to persons with autism” (Graziano, )
20 Team Approach Speech therapy Helps in developing communication skills which may include alternative forms of communication (sign language and the use of keyboards)Occupational TherapyAddresses specific needs for daily living
21 Team ApproachArt and music therapy can be used to increase communication skills, social interaction, and a sense of accomplishment.Medication may be necessary to control behaviour or sleepDietary assessment is important - a balanced diet as far as possible but with extra vitamins and/or minerals. people with autism are more susceptible to allergies and food sensitivities than the average person. The most common food sensitivity in children with autism is to gluten and casein.
22 Autism Spectrum Disorder May have to consider:AutismAsperger’s Syndrome (AS)Tourette’s Syndrome (TS)Landau Kleffner’s Syndrome (LKS)Rett SyndromeAttention Deficit/Hyperactivity Disorder (AD/HD)Specific Learning Disabilities (SLD)Childhood Disintegrative Disorder (CDD)Prader Willi SyndromeFragile-X SyndromePKUHurler’s SyndromeCornelia de Lange SyndromeWilliam’s Syndrome
23 Asperger’s Syndrome Original report: “Autistic Psychopathies in Childhood” (1944)translated into English in 1980
24 Asperger’s Observations ChildrenFind it difficult to ‘fit in’ sociallyHave poor social use of languageHave limited ability to use and understand gestures and facial expressionsUse repetitive, stereotypical behaviorsHave abnormal fixations on certain objects/ areas of interestAre vulnerable to teasing and bullying
25 Asperger’s SyndromeA pervasive developmental disorder characterized by:Impairment of two-way social interaction and general social ineptitudeSpeech which is odd/pendantic, stereotyped in content, but which is not delayedAdherence to rules, routines, ritualsLack of social reciprocityLimited non-verbal communication skills – little face expression or gesturesGenerally equated with high functioning autism.
26 Distinctions between Asperger’s Syndrome and Autism Children with autism exhibit a significant delay in language skillsChildren with Asperger’s have only mild impairments or peculiar ways of using language
27 Diagnostic Features of Asperger’s Social InteractionsSocially aloof, unconcernedInappropriate eye contact (but usually present)Peer friendships occur, but may lack strategies to develop or maintainDifficulty taking the perspective of another personMay often lack empathyBlatantly honest or straight-forward even when not in their best interestTense and distressed when trying to cope
28 Social Communication Superficially perfect spoken language May lack voice expression, difficulty interpreting different tones of voiceDifficulty interpreting and using non-verbal communication, body language, gestures, facial expressionsMay take things in a very literal wayMay fail to grasp implied meanings of languageMay not easily grasp social rules or subtletiesMay talk at length about topics that are of interest to only him/herselfUses objects in an atypical fashionInsists that others do things according to their own prescribed order and rules
29 Poor Problem Solving and Organizational Skills Difficulties in…Situations requiring “common sense”organizing thoughts and abstract reasoningTransitioning from one situation to anotherDeficits in…mental planningImpulse controlSelf monitoringStrong desire for orderliness may delay achieving goals
30 Limited Interests and Preoccupations May talk at length about topics that are of interest to only him/herselfRedirects conversations back to topics of interest even at risk of being ridiculed or shunnedFriends interested in similar thingsJobs in areas of interests
31 Pragmatic DisorderLack of understanding about the reciprocity of verbal and nonverbal communicationDecreased understanding and use of gesturesDecreased use of questionsDifficulty maintaining a conversation
32 TestsTest of Pragmatic LanguageTest of Problem Solving
33 Effective Strategies to Teach Pragmatic Language Social Language GroupsSocial Language StoriesReciprocal Conversation with TherapistRole PlayingVideotapingCoaching During Social Times
34 Language Disorder Sometimes language learning is precocious There must be words by 2 years and phrases by 3 yearsStyle of learning language may be like an autistic child: echolalia, difficulty learning pronouns, difficulty understanding verbal explanations
35 Tests Preschool Language Scale-4 Clinical Evaluation of Language The Test of Language DevelopmentExpressive One Word Vocabulary TestPeabody Picture Vocabulary Test
36 Language Test Scores Show an Unusual Profile Highest scores are in expressive vocabulary,Next highest are in receptive vocabulary,Next are in grammatical structures,Often below average are tests of problem solving,Lowest area is in pragmatic language skills.
37 Teach Flexibility COMPROMISING If you compromise, you are doing the right thing.Compromise means letting the other person have his way.If you do this, you get a bonus point.
38 Teach Flexibility BEING BOSSY Often turn other children off by being bossy, controlling and judgmental.So, they lose a point (or a turn) for teasing criticizing another child.Alternately, they get extra points for saying something nice.If the child starts out saying several nice things, he is not teased as much.