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Chapter 7 Autism Spectrum Disorders


Autistic Disorder - marked by three defining features, with onset before age: 1) ... Echolalia is common. among those who do talk ... – PowerPoint PPT presentation

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Title: Chapter 7 Autism Spectrum Disorders

Chapter 7Autism Spectrum Disorders
DSM-IV Definitions
  • Autistic Disorder - marked by three defining
    features, with onset before age 1) impaired
    social interaction, 2) impaired communication,
    and 3) restricted, repetitive, and stereotyped
    patterns of behavior, interests, and activities
  • Asperger Syndrome - impairments in all social
    areas, particularly an inability to understand
    how to interact socially
  • Rhetts Syndrome - a distinct neurological
    condition that begins between 5 and 30 months of
    age, marked by a slowing of head growth,
    stereotypic hand movements, and severe
    impairments in language and coognitive abilities
  • Childhood disintegrative disorder - shares
    characteristics with autistic disorder, but
    doesnt begin until after the age of 2 and
    sometimes not until age 10
  • Pervasive Developmental Disorder - Not Otherwise
    Specified (PDD-NOS) - diagnosis given to children
    who meet some, but not all, of the criteria for
    autistic disorder.

IDEA Definition
  • Autism is a developmental disability affecting
    verbal and nonverbal communication and social
    interaction, generally before age 3, that
    adversely affects a childs performance.

  • Impaired social relationships
  • Many children with autism do not speak.
    Echolalia is common among those who do talk
  • Varying levels of intellectual functioning,
    uneven skill development
  • Unusual responsiveness to sensory stimuli
  • Insistence on sameness
  • Ritualistic and stereotypic behavior
  • Aggressive or self-injurious behavior

  • Early diagnosis is highly correlated with
    dramatically better outcomes
  • Autism can be reliably diagnosed at 18 months of
  • Checklist for Autism in Toddlers (CHAT)
  • Modified Checklist for Autism in Toddlers

  • Childhood Autism Rating Scale (CARS)
  • Autism Diagnostic InterviewRevised
  • Gilliam Autism Rating Scale (GARS)
  • Asperger Syndrome Diagnostic Scale (ASDS)
  • It is largely based on clinical judgment

Prevalence and Causes
  • Prevalence
  • Recent estimates - Autism occurs in as many as 1
    in 150 children (CDC, 2007)
  • Boys are affected about 4 times more often than
  • Autism is the fastest-growing category in
    special education (autism epidemic)

Prevalence and Causes
  • Causes
  • The cause of autism is unknown
  • Controversial theories
  • MMR vaccine
  • Mercury (thimerosal)
  • No evidence of childhood vaccinations causing
  • There is a clear biological origin of autism in
    the form of abnormal brain development,
    structure, and/or neurochemistry
  • Genes may be responsible for the abnormality
  • Environmental factors may trigger the disorder

  • What is a science-based approach?
  • and how is it different from pseudo-science?

  • reliable and valid measurements
  • pre- post measures
  • control/comparison group(s)
  • blind or independent evaluators
  • replication
  • published in peer reviewed journals

  • No scientifically valid evidence
  • (no) controlled studies
  • (in)consistent findings
  • (not) published in peer reviewed journals
  • Use numbers and graphs
  • Ph.D.s and M.D.s Institutes

  • What does body of scientific research conclude
    about interventions with children with ASD?

Current unproven or disproven medical
  • Secretin
  • peptide hormone that stimulates the secretion of
    digestive fluids, no benefits in 3 controlled
  • Gluten Free/Casein Free Diet
  • food allergies cause or contribute to autism has
    no sound scientific evidence supporting
  • Hyperbaric oxygen
  • The logic for using hyperbaric oxygen treatment
    for developmental disorders relates to the
    auto-immune and/or viral theory of these
    conditions. Encephalitis, in this theory, is
    thought to be part of developmental disorders. No
    data on the use of hyperbaric oxygen for
    developmental disorders

Current unproven or disproven medical
  • Vitamin B6 and magnesium
  • Dimethylglycine (DMG) (Vitamin B 15)
  • AZT (Terovir)
  • Steroids
  • Antibiotics
  • Antifungal medications
  • Behavioral Optometry
  • Craniosacral therapy
  • The emphasis in Biodynamic Craniosacral Therapy
    is to help resolve the trapped forces that
    underlie and govern patterns of disease and
    fragmentation in both body and mind. This
    involves the practitioner "listening through the
    hands" to the body's subtle rhythms and any
    patterns of inertia or congestion.

Current not yet validated or disproven nonmedical
  • DIR (Greenspans Floortime)
  • Floortime is your childs practice time. Each
    time you get down on the floor and
    interactspontaneously, joyfully, following your
    childs interests and motivationsyou help him
    build that link between emotion and behavior, and
    eventually words, and in doing so move forward on
    his journey up the developmental ladder
  • Sensory Integration
  • is a complex disorder of the brain that affects
    developing children. Children with SPD
    misinterpret everyday sensory information, such
    as touch, sound, and movement.
  • RDI (Guttstein)
  • Higashi Method
  • Music Therapy
  • AIT (Auditory Integration Training)
  • Hippotherapy/Dolphin therapy
  • Occupational Therapy

Found harmful in scientific studies
  • Facilitated Communication
  • Auditory integration training
  • Intravenous immune globulin
  • withholding vaccinations

Evidence-Based Treatment
  • Applied Behavior Analysis is the only treatment
    approach that has been documented to produce
    significant gains (comprehensive and
    long-lasting) for children with ASD
  • U.S. Surgeon Generals Report
  • New York State Department of Early Intervention
    Task Force
  • 12 well-designed, peer-reviewed comparison
    studies (with over 342 subjects)
  • Hundreds of peer-reviewed studies documenting
    specific ABA procedures

Why Science?
  • Basing decisions about interventions mainly on
    preconceptions, opinions, speculations,
    subjective impressions, and badly done studies
    has many risks
  • Wasted money, time, energy
  • Exploitation of vulnerable people
  • Physical and emotional injuries
  • Lost opportunities to make real advances
  • Reinforcement and perpetuation of practices that
    impede progress
  • The most tried-and-true way to reduce those risks
    is to rely on careful scientific evaluation to
    separate opinions and beliefs from verifiable

Educational Approaches
  • Applied Behavior Analysis (ABA)
  • Discrete Trial Training
  • Picture Exchange Communication System (PECS)
  • Peer-mediated interventions
  • Errorless discrimination learning
  • Generalization
  • Functional assessment of challenging behavior
  • Pivotal response intervention
  • Naturalistic language strategies

Educational Approaches (continued)
  • Social stories
  • Picture activity schedules
  • Educational Placement Alternatives
  • Regular Classroom
  • Resource Room

Where do we start?
  • Imitation
  • Attending to environment
  • Visual auditory
  • Eye contact
  • Joint Referencing
  • Exploratory behavior
  • Shared attention

Howard, Sparkman, Cohen, Green, Stanislaw (2005)
  • Generic Early Intervention
  • Autism Programs
  • Intensive ABA
  • parental preference most significant factor in

Children in the study
  • lt48 months of age
  • Dx
  • Autism or PDDNOS
  • qualified, independent examiners
  • Intervention
  • No secondary medical condition
  • English primary language
  • No IQ cut off

Generic Early Intervention Programs
?16 staffing ratio ?15 - 17 hours per week ?gt50
individual or group Speech Tx ?Curriculum ?develop
mentally appropriate ?language rich
environments ?typical preschool activities
Autism Preschool Programs
11 or 12 staffing ratio 26 - 30 hours per
week Behavioral consultant 50 individual or
group Speech Tx Curriculum Discrete trial
component PECs TEACCH typical preschool
Intensive ABA
  • 11 staffing
  • 35 hours per week
  • errorless learning
  • gt800 trials/structured opportunities per day
  • Joint attention, imitation, and initiation
  • Speech Pathologist consultant

  • Re-contacted 1 year after baseline
  • Independent follow-up testers
  • IEP and file review
  • educational placement
  • hours and services

Participants at Baseline
Generic EI (16) Autism (16) Intensive ABA (29)
Age (mos) 35 39 31
IQ (SS) 60 54 59
Language (mos) 17 15 14
Autism Dx 72 81 82
Mother Ed (yrs) 13 13 14
Cognitive Functioning
Standard Scores
Receptive Language
Standard Scores