THE EVOLVING NOMENCLATURE OF AUTISM Kanner’s “ autism” Asperger’s syndrome Need for international classification DSM and ICD systems 1988 Autistic Disorder/ Pervasive Developmental Disorder (DSM III-DSM III R) 1994 Autistic Disorder/PDD (DSM IV- ICD 10) 1995 Autistic Spectrum Disorders

Autistic Spectrum Disorders A group of biologically based disorders which comprise a number of different medically diagnosed conditions The “shared” behavioral characteristics include a triad of impairments There is a neurologic dysfunction and genetic factors are involved

AUTISTIC SPECTRUM DISORDERS

Definition of terms Autistic Spectrum Disorder (ASD) termed Pervasive Developmental Disorders [PDDs] in the DSM 4th edition (text revision) DSM-IV-TR This refers to developmental disorders of varying clinical presentations that share a core feature of pervasive and qualitative impairments in reciprocal social interaction. Source: Carr and Le Blanc, ASDs in Early Childhood, Primary Care Clin Office Pract, 2007

THE AUTISTIC SPECTRUM Prevalence How many individuals with autism are there? 1- 6 per 1000 Fombonne 2004

Autism or Autistic Disorder To qualify for a diagnosis, they must meet 6 criteria at least 2 in social interaction one each in communication and restrictive, repetitive behavior Notes for Parents : Good sources on diagnostic criteria: DSM IV-TR The World of the Autistic Child by Bryna Siegel , 1996 p. 18 Autism Spectrum Disorders by Chantal Sicile –Kira, 2004 p. 21

Autism /Autistic Disorder Substantial social impairment , poor peer interaction Moderate to profound language impairments Restricted and repetitive behaviors

Asperger Syndrome/ Disorder To qualify for a diagnosis, there should be at least 2 characteristic criteria in social interaction 1 characteristic criteria in restricted, repetitive behavior * No language delay/cognitive impairment Notes for Parents: Good sources: Asperger Syndrome by Tony Attwood The Oasis Guide to Asperger Syndrome by Bashe and Kirby , 2005

Pervasive Developmental Disorder Not Otherwise Specified PDDNOS This diagnosis is used for “milder” problems. An individual with PDDNOS may exhibit behavior similar to those diagnosed with autism or Asperger Syndrome but does not meet the criteria for one of these disorders Food for thought Some doctors use PDDNOS provisionally when the child is so young and some criteria are felt too difficult to see

The Diagnostic Evaluation Process Medical Examination Should be performed by qualified health professional * Regression or if with clinical neurologic abnormalities like microcephaly or neurologic asymmetries Physical Exam dysmorphisms growth impairments neurocutaneous Neurologic exam neurologic abnormalities Laboratory tests as needed Genetic tests High resolution karyotype Fragile X Neurological tests EEG * MRI/CT scan * Newsweek December 4, 2006

Screening and Referral Screening for ASD should be conducted in conjunction with routine developmental surveillance RED FLAG INDICATORS No babbling by 12 months No gestures like pointing, showing, reaching or waving by 12 months No words by 16 months No 2 word meaningful phrases by 24 months ANY loss of speech, babbling and social skills at ANY age

Parental concerns that should be addressed as soon as possible Delayed or deviant language Poor social interaction ( lack of eye contact, no peer relations) Delayed language and poor social interaction Inappropriate/unusual , self injurious or aggressive behaviors + language delay Knowledge of normal development is important !

Prevalence Data “One child in 100 in the UK” “Autism is the fastest growing childhood developmental condition in the USA with 1 child in 166 affected” US Centre for Disease Control 2004 “One child in 100 in the UK” Office of National Statistics 2004 Rates for autism in 50 prevalence reports reported 50 to 80 per 10000 Blaxill M.F. 2004 www.publichealthreports.org

Increasing prevalence: Is it better detection or better awareness ? U.S. DATA Population data CDC/NCHS PHILIPPINE DATA Hospital records PGH/PCMC

THE AUTISTIC SPECTRUM a BEHAVIORAL syndrome There is a cluster of unusual behavior patterns “ The triad of impairments” poor social interaction poor social communication restricted activities and interests

Social Development in ASD No interest in playmates Pulls hand for needs

The Nature of Communication in ASD Lacks communicative intent (can learn to request and protest) Lack of joint attention (cannot direct attention to things, poor pointing , use of here vs there, my vs yours) Lack of awareness of shared knowledge or experience Lacks reason for communicating

Communication in ASD VERBAL Gestures Language delay and loss Gaze Echolalia and odd use of language Pragmatics NON VERBAL Gestures Gaze Use of space Expression of emotions