1. WHAT IS AUTISM?

2. PDD Autistic Disorder Asperger’s Disorder Rett’s Disorder Childhood Disintegrative Disorder PDD NOS

3. Pervasive Developmental Disorder (PDD) is a neurological disorder that affects a child’s ability to communicate, understand language, play, and relate to others.

4. PDD represents a distinct category of developmental disabilities that share many of the same characteristics that fall within the broad meaning of PDD: Autistic Disorder Asperger’s Disorder Rett’s Disorder Childhood Disintegrative Disorder Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)

5. IDEA “Autism” is one of the disabilities specifically defined in IDEA as “a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child’s educational performance.”

6. A diagnosis of autistic disorder is made when an individual has impairments in each of the three major areas: 1)Social Interaction 2)Communication 3)Behavior

7. Social Interaction Behavior TRIAD OF IMPAIRMENT Communication

8. Social Interaction Difficulty relating to people, objects and events: –Impairment in the use of nonverbal behaviors (inability to “read” other people) –Lack of social and emotional reciprocity (Use of parents as tools to get what they want; treat people and objects alike) –Exhibits avoidant behaviors (minimal eye contact, minimal attention to people/events) –Fails to develop relationships (no social initiative)

9. Social Interaction Unusual play with toys and other objects –Uses toys in a mechanical fashion (toys are lined up, sorted, twirled or hurled, but not used for imaginative games) –Typically does not point to toys or objects –Lacks spontaneous make-believe play (no imitation of day-to-day activities)

10. Communication Difficulty using and understanding language –Failure to develop reciprocal language (unable to grasp the concept that speech can be used to name objects, to request a toy, or to engage others) –Stereotypic speech (echolalia and delayed echolalia- repeats rhymes, jingles, or what other individuals have said; Pronoun reversal-talks in third person; unusual inflections and intonations-robotic speech) –Idiosyncratic language (no understanding of the conventional meaning of any individual words) –Talks in “chunks” (chunked phrases replace one-word utterance in early language development-repeats commercials, movies or others’ speech)

11. Communication –Pragmatic difficulties (difficulties sustaining a conversation, turn taking, and allowing the conversational partners to introduce their topics )

12. Repetitive or Stereotypic Behaviors Difficulties with changes in routine or familiar surroundings (rigid need for “sameness” in daily routines) –Development of elaborate rituals in which the order of events, the exact words, and the arrangement of objects must be followed Repetitive body movements or behavior patterns –Stereotypic movements (hand clapping, arm flapping, aimless running, rocking, spinning, licking, flicking fingers, flicking pages of books, etc.)

13. Repetitive or Stereotypic Behaviors Pronounced sensory issues (either overreaction or underreaction to sensory stimulation) –Sound –Touch and textures –Tastes –Smells These behaviors may have a calming/soothing effect that surface in times of stress

14. ADOS Autism Diagnostic Observation Schedule A Semi-Structured Standardized Assessment of :  Communication  Social Interaction  Play or Imaginative Use of Materials

15. Medical DX vs. Educational Eligibility Medical Diagnosis − DSM IV − Clinical Judgment − Rating Scales Observations Educational Identification − IDEA Regulations − Team Assessment − Structured

16. ADOS 4 Modules for: Development & Language Levels Module 1: No speech to simple phrases Module 2: Meaningful 3-word phrase with verb Module 3: Verbally fluent (Child/Adolescent) Module 4: Verbally fluent (Adolescent/Adult)

17. ADOS as a Clinical Instrument Creates a “social world” Structured and unstructured activities Guidelines for a “hierarchy” of examiner’s behavior and verbal prompts Flexibility of instrument and examiner Dependent on examiner’s experiences and sensitivity (to act and not to act)

18. ADOS Administration Time: 30 – 45 minutes Work as a Team Practice = Reliability