2Overview 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?
3WHAT 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
4WHAT IS AUTISM?Today, autism is a severe form of a broader group of disordersThese are referred to as pervasive developmental disordersTypically appears during the first 3 years of life
5WHAT IS AUTISM?Very likely neurological in origin – not emotional, not the refrigerator momPrevalence 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 boysNo known racial, ethnic, or social boundariesNo relation to family income, lifestyle
6WHAT 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.
7WHAT IS AUTISM?May exhibit repeated body movements (hand flapping, rocking).Unusual responses to peopleAttachment to objectsResistance to change in routineSensory sensitivities
8WHAT 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 deficitsDiffer in terms of severity
101. Autistic DisorderImpairments in social interaction, communication, and imaginative play.Apparent before age 3.Also includes stereotyped behaviors, interests, and activities
112. Asperger’s DisorderImpairments in social interactions, and presence of restricted interests and activitiesNo clinically significant general delay in languageAverage to above average intelligence
123. Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) Often referred to as atypical autismUsed when a child does not meet the criteria for a specific diagnosis, but there is severe and pervasive impairment in specified behaviors
134. Rett’s DisorderProgressive disorder which, to date, has only occurred in girls.Period of normal development and then the loss of previously acquired skillsAlso loss of purposeful use of hands, which is replaced by repetitive hand movementsBeginning at age of 1-4 years
145. Childhood Disintegrative Disorder Normal development for at least the first 2 yearsThen significant loss of previously acquired skills
15Conclusions on Types Autism is a spectrum disorder This means that symptoms and characteristics can present themselves in wide variety of combinations, from mild to severeAutistic individuals can be very different from each other“Autism” is still commonly used to refer to any of the 5 PDDs
16What causes (and doesn’t cause) autism? Good agreement in general that autism is caused by abnormalities in brain development, neurochemistry and genetic factorsSome 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?
17How is Autism Diagnosed? No definitive medical testTeam 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
18CHARACTERISTICS 1. Communication/Language 2. Social Interaction 3. Behaviors4. Sensory and movement disorders5. Resistance to change (predictability)6. Intellectual functioning
191. Communication/language Broad range of abilities, from no verbal communication to quite complex skillsTwo common impairments:A. Delayed languageB. Echolalia
20A. Delayed language50% of autistic individuals will eventually have useful speech (?)Pronoun reversal: “You want white icing on chocolate cake.”Difficulty in conversing easily with othersDifficulty in shifting topicsLook away; poor eye contactFacilitated communication?
21Elements of Facilitated Communication 1. Physical Support2. Initial training/introduction3. Maintaining focus4. Avoiding competence testing5. Generalization6. Fading
22B. EcholaliaInvoluntary parrot-like repetition (echoing) of a word or phrase just spoken by another person.Common in very young children (Age 3)Immediate or delayedIs there communicative intent with echolalia?
232. Social InteractionOne of hallmarks of autism is lack of social interaction1. Impaired use of nonverbal behavior2. Lack of peer relationships3. Failure to spontaneously share enjoyment, interests, etc. with others4. Lack of reciprocityTheory of mind?
243. BehaviorsRepetitive behaviors, including obsessions, tics, and perseverationImpeding behaviors (impede their learning or the learning of others)Will need positive behavior supportsA. Self-injurious behaviorB. Aggression
254. Sensory and movement disorders Very commonOver- or under-sensitive to sensory stimuliAbnormal posture and movements of the face, head, trunk, and limbsAbnormal eye movementsRepeated gestures and mannerismsMovement disorders can be detected very early – perhaps at birth
265. Predictability Change in routine is very stressful May insist on particular furniture arrangement, food at meals, TV showsSymmetry is often importantInterventions need to focus on preparing students for change if possible
276. Intellectual functioning Autism occurs in children of all levels of intelligence, from those who are gifted to those who have mental retardationIn general, majority of individuals with autism are also identified as having mental retardation – 75% below 70Verbal and reasoning skills are difficultSavant syndrome
28Interventions 1. Individualization and early intervention are the keys 2. Include life skills, functional academics, and vocational preparation3. Positive behavior support4. 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.
301 to 1.5 million Americans <2> Facts and Statistics1 in 150 births <1> Only 20 years ago the statistics were 1 in 10,000.4:1 ratio of boys to girls1 in 98 boys1 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 2003There are more than 500,000 individuals under the age of 21 with some form of Autism right now in the United States.
31Incidence 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
33Autism Society of Oregon Autism OrganizationsOregon:Autism Society of OregonUSA:Asperger and Autism Information by MAAP ServicesAutism National Committee (AUTCOM/ANC)Autism Network International (ANI)Autism Society of AmericaAutism SpeaksCenter for the Study of AutismFamilies for Early Autism Treatment (FEAT) of Northern CaliforniaSociety for Auditory Integration Training