1. Clinical and Research Program in Pediatric Psychopharmacology
Features of AUTISM
CORE Features
Impaired Social-Emotional Competence
Restricted/Repetitive Behaviors (RRBs)
Non-verbal communication
- Eye contact (joint-attention)
Cognitive Rigidity
- Routines / rituals
(rule-bound/transitional difficulties/lack spontaneity)
Social-emotional reciprocity
- Empathy
- Sharing (activities, affect, conversations)
- Social flexibility
- Contextual understanding
Repetitive patterns
- Speech (Delayed echolalia, Scripting)
- Motor mannerisms (Flapping, Clapping, Rocking, Swaying)
- Interests
Social-emotional Salience
- Relevant social-emotional stimulus
Atypical Salience
- Idiosyncratic (odd) Interests
Abstracting ability
- Black & white/concrete/literal thinking
- Tolerance for unstructured time, ambiguity
Sensory Dysregulation
- Atypical sensory perceptions/responses
- Introsceptive ability
Introspective/Introceptive ability
(self awareness of cognitions, emotions, & physiological state)
- Psychological mindedness
Executive Functions
(Control/moderation of emotions, motivations, interests)
- All or none approach
- Abnormal intensity of interests
Convictions
Passions
Opinionated
Difficulty moderating (all or none)
- Mood/Emotions
- Cognitions (black and white)
- Motivation
- Interests
- Relationships
- Social boundaries
- Rate of speech
Lack contextual adaptability x
Developmental transitions (rigidity)
ASSOCIATED Features
Poor motor coordination
Novelty averse behaviors
Atypical fear response
Self-injurious behaviors
Clinical and Research Program in Pediatric Psychopharmacology

2. DSM Criteria for Autism
Schizophrenic reaction
- Childhood Type
Schizophrenia
- Childhood Type
Infantile Autism
DSM-I
(1952)
DSM-II
(1968)
DSM-III
(1980)
Pervasive Developmental Disorders
Pervasive Developmental Disorders
Autism Spectrum Disorder
DSM I (1952) Schizophrenic reaction, childhood type (Psychotic reaction in children with Autism)
DSM II (1968) Schizophrenia, childhood type (This category is for cases in which schizophrenic symptoms appear before puberty. The condition may be manifested by autistic, atypical and withdrawn behavior)
DSM III (1980) Infantile Autism
Criteria for Infantile Autism
A. Onset before 30 months of age 

B. Pervasive lack of responsiveness to other people (autism) 

C. Gross deficits in language development

D. If speech is present, peculiar speech patterns such as immediate and delayed echolalia, metaphorical language, pronominal reversal.

E. Bizarre responses to various aspects of the environment, e.g., resistance to change, peculiar interest in or attachments to animate or inanimate objects.

F. Absence of delusions, hallucinations, loosening of associations, and incoherence as in Schizophrenia.
DSM-III-R
(1987)
DSM-IV-R
(1994/2000)
DSM-5
(2013)
Clinical and Research Program in Pediatric Psychopharmacology

3. Autism Spectrum Disorder (299.00)
DSM-5 Diagnostic Criteria for Autism
Autism Spectrum Disorder (299.00)
______
________
Clinical and Research Program in Pediatric Psychopharmacology

4. Autism Spectrum Disorder
Prevalence of
Autism Spectrum Disorder
Children with ASD
ADDM Network
Children 8 years old
Medical records reviewed by trained clinicians
SURVEYS ASSESSING PREVALENCE OF ASD IN GENERAL POPULATION
ADDM 2008 Survey
- Individuals with an ASD had average medical expenditures that exceeded those without an ASD by $4,110–$6,200 per year.
Medical expenditures for individuals with an ASD were 4.1–6.2 times greater than for those without an ASD.
Differences in median expenditures ranged from $2,240 to $3,360 per year with median expenditures 8.4–9.5 times greater.
Children with ASD have higher annual mean number of psychiatric (2.2 vs 0.3) outpatient visits and are nearly 9 times more likely to use psychotherapeutic medications than children without ASD (43% vs. 5.0%) (Croen et al., 2006). The financial burden of health care (average annual cost) is reported to be 3 times higher for those ASD individuals with psychiatric comorbidities than those without ($4849 vs $1682).
7/1000
15/1000
Prevalence of ASD has more than DOUBLED between 2002 & 2010
and is increasing at the rate of % / year
Centers for Disease Control & Prevention (CDC) Surveys: ADDM Network Surveys 2000, 2002, 2004, 2006, 2008, & 2010

5. Prevalence of ASD Substantial rise in the prevalence of AUTISM
Intellectually Capable
Intellectually Impaired
ADDM 2008 Survey
- Individuals with an ASD had average medical expenditures that exceeded those without an ASD by $4,110–$6,200 per year.
Medical expenditures for individuals with an ASD were 4.1–6.2 times greater than for those without an ASD.
Differences in median expenditures ranged from $2,240 to $3,360 per year with median expenditures 8.4–9.5 times greater.
Children with ASD have higher annual mean number of psychiatric (2.2 vs 0.3) outpatient visits and are nearly 9 times more likely to use psychotherapeutic medications than children without ASD (43% vs. 5.0%) (Croen et al., 2006). The financial burden of health care (average annual cost) is reported to be 3 times higher for those ASD individuals with psychiatric comorbidities than those without ($4849 vs $1682).
Substantial rise in the prevalence of AUTISM
in intellectually capable populations
Centers for Disease Control & Prevention (CDC) Surveys: ADDM Network Surveys 2000, 2002, 2004, 2006, 2008, & 2010

6. Intelligence Profile in AUTISM
Intellectual
Disability
[ID]
Autism Spectrum Disorder
With ID
[Low-Functioning]
High-Functioning
IMPAIRED IQ
Intelligence Quotient (IQ)
Domains of Autism
Non-verbal Communication
Emotional Processing (awareness/perception, motivation, response)
Empathy (ToM; perspective taking [relating with others])
Social Processing (awareness, motivation, response)
Restricted-Repetitive Behaviors (interests, routines)
Cognitive Flexibility (rigid routine, poor social adaptability, rigid thinking, transitional difficulties, novelty averse, inability to share)
Sensory Dysregulation (hypersensitive, hyposensitive)
Abstract Thinking (Concrete/literal, black & white example; tolerate ambiguity, tolerate unstructured time)
Salience (emotions, physiological, cognitive, social)
Executive Control (emotions, motivations, interests)
Introspective ability (self awareness, self reflection, psychological mindedness)
Affective speech
Reading emotions (non-verbally in others and within self)
Cognitive domains of development – Intellectual, social, and emotional
Social – emotional relatedness
Emotional Capacity – Empathy,
OTHER FEATURES
Social & emotional salience (forest for the trees, registering socially and emotionally relavent stiulii)
Sensory Dysregulation
Concrete/literal
Restricted-Repetitive Behaviors
Emotional Processing
Empathy (ToM)
Social Processing
Cognitive Flexibility
Abstract Thinking (Concrete/literal)
Introspective ability
Social-emotional immaturity, understanding, competence, capicity,
Non-verbal
Asocial
Verbal
Socially curious
Clinical and Research Program in Pediatric Psychopharmacology

7. The Alan & Lorraine Bressler Program for Autism Spectrum Disorder
Social-emotion Competence Across the Lifespan
Preschool
Latency
Teenage
Young Adult
Adult
(0–5 years)
(6–12 years)
(13–18 years)
(19–35 years)
(≥36 years)
Minimal social- emotion demands
± Superior intellectual capacity
Socially isolated
Bullied
Impaired intellectual functioning
Social difficulties
(friends, prom, dating)
Impaired intellectual performance
± Intellectual success
Challenges:
-Social & relationship
-transition to adulthood
Delayed social milestones (marriage, children)
Social-emotional isolation
Sensory Dysregulation
Present with ADHD
At risk for depression, anxiety, psychosis
At risk for drug abuse
Suffer from anxiety & mood dysregulation
Social phase
Professional Phase
Areas of
Social-emotional Development
- Non-verbal communication skills
- Social skills
- Empathy
- Abstracting ability
- Cognitive Flexibility
- Executive Control
- Introspective ability
Typical Development
AUTISM
Capacity
Competence
Demands: Peers develop these skill set; Developmental expectations (less flexible environment)
Disability
Social-emotional maturity curve
The Alan & Lorraine Bressler Program for Autism Spectrum Disorder