1. Autism Spectrum Disorders: An Introduction Rhea Paul, Ph.D., CCC-SLP Southern Connecticut State University Yale Child Study Center Feb. 11-15, 2008 rhea.paul@yale.edu www.autism.fm

3. Another Way to Look at it

4. Autistic Disorder Impairment in social interaction-at least 2 of: Gaze, facial expression, gesture impairments Failure to develop peer relationships Lack of seeking to share with others Lack of reciprocity Impairment in communication-at least 1 of: Delay in language Impairment in conversation ability Stereotyped and repetitive langauge Lack of pretend play Restricted, repetitive stereotyped behavior, interests, activities-at least 2 of: Preoccupations with abnormal focus or intensity Rigid need for routine or ritual Motor mannerisms Preoccupation with parts of objects Onset before age 3

5. Autistic Disorder- 3 Examples http://www.youtube.co m/watch?v=kSB_BQgO Ex0&feature=related

6. Asperger Syndrome in DSM-IV Impairment in social interactionn (same as autism) Restricted, repetitive stereotyped behavior, interests No clinically significant general delay (CSD) in language No CSD in cognitive, self-help, or adaptive skills

7. Asperger Syndrome http://www.youtube.com/watch?v=Zu4z- ZKZZo4&feature=related

8. Normal early development in girls Head growth deceleration Loss of purposeful hand movements Development of "autistic-like" features Characteristic course Other unusual Behaviors: aerophagia tongue pulling Medical problems: Scoliosis movement problems Rett Syndrome, 1966

9. Rett Syndrome Video Sample http://www.youtube.com/watch?v=ZBsEwg_yuDQ&feature=related

10. Childhood Disintegrative Disorder Heller, 1908 Period of Normal Development (years) Usually seen in males Marked Regression (multiple areas) Sometimes CNS insult Usually minimal recovery Usually as severe or more severe than classic autism Usually poor long-term prognosis

11. PDD-NOS Atypical autism More prevalent than classic autism Are there subgroups/types? DSM-IV: severe, pervasive impairment in reciprocal social interaction AND in EITHER:  Verbal or nonverbal communication Restricted, repetitive stereotyped behavior, interests, or activities

12. PDD-NOS JK

13. PDDs in DSM-IV Always associated with MR Childhood Disintegrative Disorder or Heller’s syndrome Rett’s Syndrome May or may not be associated with MR Autism Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) Usually not associated with MR Asperger Syndrome (AS) High Functioning Autism (HFA)

14. Cognition 75% of people with ASD function in the MR Range  Considerations  Appropriate test  Stability of scores  Scatter is common  Islets of ability  "autistic savants”  Improvement with early intervention

15. Savant Abilities or Splinter Skills Drawing: Nadia, Age 3

16. Drawing Stephen Wiltshire

17. Musical Ability Blind Tom

18. Calculation Mathematics Calendar

19. Etiology of Autism  Early focus on parents  Psychodynamic views, Kanner, Bettleheim  BUT evidence against  No abnormalities in child care  No major personality problems  No obvious deficits in parenting  By 1970's a large body of evidence favoring neurobiological etiology

20. Prevalence Used to be thought rare Current estimates: Autism: 1/1000 - 2/10,000 Is the frequency of autism increasing? Rett=s and CDD very rare - ? 1/15,000 Asperger=s - ? 1/7,000 PDD-NOS - ? 1/200

21. Is the incidence increasing? No question that more cases are being identified but is there a ‘real’ increase? Changes in definition Better diagnosis at both ‘ends’ of the spectrum Growing awareness of the condition Educational implications of label (for services) Diagnostic substitution

22. Do vaccines cause autism? Several large, international epidemiological studies refute association children get vaccines at 18 mo.; ASD often becomes obvious at this age Autism rates in Japan continued to rise after the withdrawal of MMR vaccine. Honda et al. No effect of MMR withdrawal on the incidence of autism: a total population study. Journal of Child Psychology and Psychiatry 2005 Mercury additives said to be cause were removed BEFORE increases in prevalence were seen Children should be vaccinated; danger of not vaccinating is greater than dangers of inoculation.

24. Genetics of Autism Early impression - no genetics But condition rare, cases don=t usually reproduce Subsequent research: risk in identical twins rate in sibs (2%) associated problems in sibs

25. Functional Classification High Functioning Includes HFA, AS, and PDD-NOS IQ within or near normal range  but adaptive behavior much lower Fluent, functional language by age 6 Low Functioning Includes Autism, PDD-NOS, Rett syndrome, CDD IQ and adaptive behavior significantly low (<70) No speech, or small single word/sign vocabulary with a few phrases, mostly rote or echolalic

26. Developmental Changes Preschool: most "classic" autistic features Sometimes not all features are exhibited until age 3 Some children respond dramatically to intervention School age: social interest & behavior problems Adolescence: gains & losses, seizures onset Adulthood: About 1/3rd have some degree of independence Many individuals require high levels of support

27. Predictors of Outcome in Autism Presence of communicative speech by age 6 Outcome worse if child is mute or has speech which is not really used for communication Nonverbal IQ in the normal range Less classic cases (PDD-NOS) = better outcome Seizures are more common with lower IQ

28. Outcomes in autism 1-2% of cases achieve normal outcome Live independently and hold down job 1/3 have some degree of independence 2/3 require high levels of support Reports of cures should be viewed with caution BUT Future outcomes may improve due to Earlier detection Better and more sustained intervention Mandates for service

29. Adult Outcome: 1981 vs. 1994 Limitations of available data DeMyer, et al., 1981 Goode, Rutter, & Howlin, 1994

30. Autism: Shades of Difference Video http://abcnews.go.com/Video/playerIndex?id=2 286327 http://abcnews.go.com/Video/playerIndex?id=2 286327 http://www.autismspeaks.org/video/glossary.p hp http://www.autismspeaks.org/video/glossary.p hp