1. What is Autism? Shirley Alleyne M.B.B.S Paediatric & Adult Psychiatrist

4. What is Autism Spectrum Disorder?

5. Autism Spectrum Disorder (Objectives)  Define Autism Spectrum Disorder (ASD)  Review Epidemiology & Aetiology  Discuss early signs and symptoms

6. Autism Spectrum Disorder (Objectives) Review:  The diagnostic process  Evidence based intervention in 2015  Resources for the management of ASD

7. Autism Spectrum Disorder (Definition) Abnormalities In:  Social Interaction  Communication  Restricted interest  Stereotyped behaviour

9. Autism Spectrum Disorder (Demographics-International)  Medium prevalence of ASD 1.3/1000  M:F = 4:1  No socioeconomic bias  More common in children of older PARENTS

10. Autism Spectrum Disorder (Demographics- Caribbean)  Aruba prevalence 5.3/ 1000 children (Balkom et al 2009)  Jamaica- mean age of parental concern 21+months/+/-10 months.  Jamaica-mean age of accessing intervention 44 months.  Jamaica-% of teachers and medical providers who referred on first contact 5.6% & 4.6% respectively. (Samms-Vaughan et Franklin-Benton 2015)

11. Autism Spectrum Disorder (Etiology)  Unknown  Genetics-5% common & rare variant  18.7% recurrence rates

13. Autism Spectrum Disorder (Early Intervention-Screening)  Routine assessment of communication and social relatedness  Use of screeners- M-CHAT at 18 and 24 months

14. Autism Spectrum Disorder (Diagnosis)  Based on knowledge of typical development  Based on clinical history  Based on clinical observations  May include the use of diagnostic tools (ADOS, ADI etc)  Genetic testing is recommended

15. Autism Spectrum Disorder (Diagnotic Criteria) PERSISTENT deficits in: Social Communication  Poor eye contact  One sided conversations  Limited facial expression & use of gestures

16. Autism Spectrum Disorder (Diagnotic Criteria) PERSISTENT deficits in: Social Interaction  Unable to initiate or maintain social interactions  Poor interest in others  Inability to read nonverbal cues  Inability to adjust to changes in the social environment

17. Autism Spectrum Disorder (Diagnotic Criteria) Restricted, Repetitive Behaviours,Interests or Activities  Stereotyped motor movements, use of objects or speech  Insistence on sameness  Highly restricted fixation interests  Hypo or hyperactivity to sensory inputs

19. Autism Spectrum Disorder (Early Intervention & Outcomes) Early Intervention  Capitalizes on increase brain plasticity in early childhood  Proven to improve long-term prognosis  Proven to improve communication and social skills  Proven to improve intelligence

20. Autism Spectrum Disorder (Management)  Communication Intervention  Educational Intervention  Behavioural Interventions  Pharmacotherapy  Alternative/Complimentary treatments  Supportive Psychotherapy-Family

21. Steve Wiltshire- renown Artist, person with ASD. “Hope is being able to see that there is light despite all of the darkness”- Desmond Tutu

22. Autism Spectrum Disorder (Resources on Island)  The Albert C. Graham Development Centre  Sunshine Early Stimulation Centre  The John Payne School  Schoolhouse for Special Needs  The Learning Centre  The Derrick Smith Secondary School  The Autism Association of Barbados  Spectrum Possibilities Charity

23. Autism Spectrum Disorder (Resources)  www.cdc.gov www.cdc.gov  www.babycenter.com www.babycenter.com  www.autismspeaks.org www.autismspeaks.org  www.autismsource.org www.autismsource.org  www.aacap.org www.aacap.org  www.aap.org  www.healthychildren.org www.healthychildren.org  www.autism.kennedykrieger.org

24. Autism Spectrum Disorder (References)  Tchaconas, A., & Adesman, A. (2013). Autism spectrum disorders: a pediatric overview and update. Current opinion in pediatrics, 25(1), 130-143.  Volmar, Fred et Al.Practice Parameter for the Assessment and Treatment of Children and Adolescents with Autism Spectrum Disorder www.aacap.org (JAACAP Vol 53 2014)www.aacap.org  van Balkom, I. D., Bresnahan, M., Vogtländer, M. F., van Hoeken, D., Minderaa, R. B., Susser, E., & Hoek, H. W. (2009). Prevalence of treated autism spectrum disorders in Aruba. Journal of neurodevelopmental disorders, 1(3), 197-204.  Samms‐Vaughan, M., & Franklyn‐Banton, L. (2008). The role of early childhood professionals in the early identification of autistic disorder. International Journal of Early Years Education, 16(1), 75-84.

25. Autism Spectrum Disorder (References)  Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J.,... & Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics, 125(1), e17-e23.  Wetherby, A. M., Guthrie, W., Woods, J., Schatschneider, C., Holland, R. D., Morgan, L., & Lord, C. (2014). Parent-Implemented Social Intervention for Toddlers With Autism: An RCT. Pediatrics, 134(6), 1084- 1093.  Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized Comparative Efficacy Study of Parent-Mediated Interventions for Toddlers With Autism.

26. Shirley Alleyne cpapsclinic@gmail.com www.cpapsclinic.com cpapsclinic@gmail.com THANK-YOU