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Autism and Autism Spectrum Disorders


Autism and Autism Spectrum Disorders Professor Graham Martin OAM Director Child and Adolescent Psychiatry The University of Queensland Autism A severely disabling ... – PowerPoint PPT presentation

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Title: Autism and Autism Spectrum Disorders

Autism andAutism Spectrum Disorders
  • Professor Graham Martin OAM
  • Director Child and Adolescent Psychiatry
  • The University of Queensland

  • A severely disabling condition that develops in
    first 3 years of life
  • Occurs approx 1 in every 5-600 births
  • More common in boys (41)
  • Features vary from child to child, and differ in
    severity from child to child
  • No influence from ethnic, racial, social factors,
    income, lifestyle or parental educational levels

Common Features
  • Communication problems
  • Both verbal and non-verbal, with relative lack of
    speech, repeated words, phrases or patterns
  • Limited Social Interactions
  • Poor eye contact and difficulty interacting
  • Difficulties expressing emotions
  • Poor perception of how others think and feel
  • Repetitive Behaviours
  • repeating words or actions
  • obsessively following routines

Causes of Autism
  • Genetic
  • 12 or more genes on different chromosomes may be
  • Genes may
  • make a person more susceptible to impact of (say)
  • directly cause specific symptoms
  • determine severity of symptoms

Likely Chromosomes and Genes
  • Chromosome 2
  • Chromosome 7
  • Chromosome 13
  • Chromosome 15
  • Chromosome 16
  • Chromosome 17
  • The X Chromosome
  • HOXA1
  • HOXD1
  • Gamma-amino-butyric acid (GABA) pathway genes
  • consensus that it is Polygenetic (gt10)

Other Causes
  • 24 of cases overlap other genetic medical
  • Fragile X Syndrome
  • Tuberous Sclerosis, Phenylketonuria (PKU)
  • Rett Syndrome
  • Other possible causes
  • in utero rubella
  • encephalopathy
  • cytomegalovirus

Diagnostic Criteria
  • 6 items at least 2 from (1), 1 each from (2)
  • (1) Qualitative impairment in social
    interaction, as manifested by at least two of the
  • Marked impairment in the use of multiple non
    verbal behaviors such as eye- to- eye gaze,
    facial expression, body postures, and gestures to
    regulate social interaction.
  • Failure to develop peer relationships
    appropriate to developmental level
  • A lack of spontaneous seeking to share
    enjoyment, interests, or achievements with other
    people (e.g., by lack of showing, bringing, or
    pointing out objects of interest)
  • Lack of social or emotional reciprocity

Diagnostic Criteria (2)
  • Qualitative impairments in communication as
    manifested by at least one of the following
  • Delay in, or total lack of, the development of
    spoken language (not accompanied by an attempt to
    compensate through alternative modes of
    communication such as gesture or mime)
  • In individuals with adequate speech, marked
    impairment in the ability to initiate or sustain
    a conversation with others.
  • Stereotyped and repetitive use of language or
    idiosyncratic language, or copying of language
  • Lack of varied, spontaneous make- believe play or
    social imitative play appropriate to
    developmental level.

Diagnostic Criteria (3)
  • Restricted repetitive and stereotyped patterns of
    behavior, interests and activities, as manifested
    by at least two of the following
  • Encompassing preoccupation with one or more
    stereotyped and restricted patterns of interest
    that is abnormal either in intensity or focus.
  • Apparently inflexible adherence to specific,
    nonfunctional routines or rituals
  • Stereotyped and repetitive motor mannerisms (e.g.
    hand or finger flapping or twisting or complex
    whole body movements or copying of movements
  • Persistent preoccupation with parts of objects.

Diagnostic Criteria
  • B. Delays or abnormal functioning in at least one
    of the following areas, with onset prior to age
    three years
  • Social interaction
  • Language as used in social communication or
  • Symbolic or imaginative play
  • C. Not better accounted for by Rett disorder or
    childhood disintegrative disorder.

Sensory Changes
  • Overly sensitive to touch (may have a tactile
  • Under-responsive to pain
  • Senses may be affected to a lesser or greater
  • No real fear of dangers

  • Lack of social interaction in play - which is
    more solitary
  • Lack of spontaneous or imaginative play
  • Does not imitate others actions
  • Does not initiate pretend games
  • Sustained odd play

  • Overactive or Passive
  • Temper tantrums for no apparent reason
  • May perseverate on a single item, idea, person
  • Apparent lack of common sense
  • May show aggression or violent behaviours
  • May injure themselves deliberately for no
    apparent reason
  • May spin objects, line things up, organize
  • Inappropriate attachment to objects
  • Unresponsive to normal teaching methods
  • Insistence on sameness resists change in routine
  • Uneven gross/fine motor skills (may not can kick
    ball but can stack chairs)

Absolute Indications For ASD Assessment
  • No babbling, or pointing, or other gestures by 12
  • No single words by 16months
  • No 2-word spontaneous phrases by 24 months
  • any loss of any language
  • any loss of social skills at any age

Specific Screen for Autism
  • Full audiological assessment, lead screen if pica
  • Autism Screening Q
  • Australian Scale for Aspergers Syndrome
  • then refer for intervention and autism specific

Specific Autism evaluationDiagnostic Parental
  • Gilliam Autism Rating Scale (GARS)
  • Parent Interview for Autism
  • The Pervasive Developmental Disorders Screening
    Test ( PDDST)
  • Autism Diagnostic Interview- Revised (ADI-R)

Diagnostic Observation Instruments
  • The Childhood Autism Rating Scale (CARS)
  • The Autism Diagnostic Observation Schedule (ADOS)

  • There is no cure for autism.
  • Treatment and education approaches may reduce
    some challenges associated with the disability.
  • Intervention may lessen disruptive behaviours.
  • Education can teach self-help skills for greater
  • Intervention needs to be tailored to the
    individual, and their family

Behaviour Therapy
  • Most widely used and successful method is
    intensive behavioural intervention (IBI)
  • We believe that behavior modification carried
    out in systematic, highly individualized, daily
    programming is the best overall approach now
    available to persons with autism (Graziano, )

Team Approach
  • Speech therapy
  • Helps in developing communication skills which
    may include alternative forms of communication
    (sign language and the use of keyboards)
  • Occupational Therapy
  • Addresses specific needs for daily living

Team Approach
  • Art and music therapy can be used to increase
    communication skills, social interaction, and a
    sense of accomplishment.
  • Medication may be necessary to control behaviour
    or sleep
  • Dietary assessment is important - a balanced
    diet as far as possible but with extra vitamins
    and/or minerals. people with autism are more
    susceptible to allergies and food sensitivities
    than the average person. The most common food
    sensitivity in children with autism is to gluten
    and casein.

Autism Spectrum Disorder
  • May have to consider
  • Autism
  • Aspergers Syndrome (AS)
  • Tourettes Syndrome (TS)
  • Landau Kleffners Syndrome (LKS)
  • Rett Syndrome
  • Attention Deficit/Hyperactivity Disorder (AD/HD)
  • Specific Learning Disabilities (SLD)
  • Childhood Disintegrative Disorder (CDD)
  • Prader Willi Syndrome
  • Fragile-X Syndrome
  • PKU
  • Hurlers Syndrome
  • Cornelia de Lange Syndrome
  • Williams Syndrome

Aspergers Syndrome
  • Original report
  • Autistic Psychopathies in Childhood (1944)
  • translated into English in 1980

Aspergers Observations
  • Children
  • Find it difficult to fit in socially
  • Have poor social use of language
  • Have limited ability to use and understand
    gestures and facial expressions
  • Use repetitive, stereotypical behaviors
  • Have abnormal fixations on certain objects/ areas
    of interest
  • Are vulnerable to teasing and bullying

Aspergers Syndrome
  • A pervasive developmental disorder characterized
  • Impairment of two-way social interaction and
    general social ineptitude
  • Speech which is odd/pendantic, stereotyped in
    content, but which is not delayed
  • Adherence to rules, routines, rituals
  • Lack of social reciprocity
  • Limited non-verbal communication skills little
    face expression or gestures
  • Generally equated with high functioning autism.

Distinctions between Aspergers Syndrome and
  • Children with autism exhibit a significant delay
    in language skills
  • Children with Aspergers have only mild
    impairments or peculiar ways of using language

Diagnostic Features of Aspergers
  • Social Interactions
  • Socially aloof, unconcerned
  • Inappropriate eye contact (but usually present)
  • Peer friendships occur, but may lack strategies
    to develop or maintain
  • Difficulty taking the perspective of another
  • May often lack empathy
  • Blatantly honest or straight-forward even when
    not in their best interest
  • Tense and distressed when trying to cope

Social Communication
  • Superficially perfect spoken language
  • May lack voice expression, difficulty
    interpreting different tones of voice
  • Difficulty interpreting and using non-verbal
    communication, body language, gestures, facial
  • May take things in a very literal way
  • May fail to grasp implied meanings of language
  • May not easily grasp social rules or subtleties
  • May talk at length about topics that are of
    interest to only him/herself
  • Uses objects in an atypical fashion
  • Insists that others do things according to their
    own prescribed order and rules

Poor Problem Solving and Organizational Skills
  • Difficulties in
  • Situations requiring common sense
  • organizing thoughts and abstract reasoning
  • Transitioning from one situation to another
  • Deficits in
  • mental planning
  • Impulse control
  • Self monitoring
  • Strong desire for orderliness may delay achieving

Limited Interests and Preoccupations
  • May talk at length about topics that are of
    interest to only him/herself
  • Redirects conversations back to topics of
    interest even at risk of being ridiculed or
  • Friends interested in similar things
  • Jobs in areas of interests

Pragmatic Disorder
  • Lack of understanding about the reciprocity of
    verbal and nonverbal communication
  • Decreased understanding and use of gestures
  • Decreased use of questions
  • Difficulty maintaining a conversation

  • Test of Pragmatic Language
  • Test of Problem Solving

Effective Strategies to Teach Pragmatic Language
  • Social Language Groups
  • Social Language Stories
  • Reciprocal Conversation with Therapist
  • Role Playing
  • Videotaping
  • Coaching During Social Times

Language Disorder
  • Sometimes language learning is precocious
  • There must be words by 2 years and phrases by 3
  • Style of learning language may be like an
    autistic child echolalia, difficulty learning
    pronouns, difficulty understanding verbal

  • Preschool Language Scale-4
  • Clinical Evaluation of Language
  • The Test of Language Development
  • Expressive One Word Vocabulary Test
  • Peabody Picture Vocabulary Test

Language Test Scores Show an Unusual Profile
  • Highest scores are in expressive vocabulary,
  • Next highest are in receptive vocabulary,
  • Next are in grammatical structures,
  • Often below average are tests of problem solving,
  • Lowest area is in pragmatic language skills.

Teach Flexibility
  • If you compromise, you are doing the right thing.
  • Compromise means letting the other person have
    his way.
  • If you do this, you get a bonus point.

Teach Flexibility
  • Often turn other children off by being bossy,
    controlling and judgmental.
  • So, they lose a point (or a turn) for teasing
    criticizing another child.
  • Alternately, they get extra points for saying
    something nice.
  • If the child starts out saying several nice
    things, he is not teased as much.