Manovikasindia.org.in Dr. Alok Post Box: 9540, Delhi-110095, India alok_bhuwan@hotmail.com AUTISM.
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manovikasindia.org.in
Dr. Alok
Post Box: 9540, Delhi-110095, India
alok_bhuwan@hotmail.com
AUTISM AUTISM
manovikasindia.org.in
Facts. . .Facts. . .
AutismAutismGeneticGenetic
Environmental Environmental FactorsFactors
Personal Personal FactorsFactors
Body Function & Body Function & StructureStructure
Brain structures, Brain structures, neurotransmitters, sensory neurotransmitters, sensory
processingprocessing
ActivitiesActivitiesPlay skills,Play skills,
Social skills,Social skills,Communication skills,Communication skills,
BehaviorBehavior
ParticipationParticipationRecreation/Leisure,
Relationship, education
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DefinitionDefinition
AutismA spectrum of neuropsychiatric disorders characterized by deficits in social interaction and communication, and unusual and repetitive behavior.
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What is AutismWhat is Autism
Autism is a Pervasive Developmental Disorder (PDD)
Who, what, when where why?
The human brain-normal and abnormal development
Genetics
Language and cognition
Social implications
Interventions and therapies
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What is developmental What is developmental disorder/disabilitydisorder/disability
Birth defects Developmental Disabilities-Cerebral palsy-Down’s syndrome-Learning disabilities and ADHD-Autism and PDDs
-Spina bifida-Heart defects-Cleft palate/club foot-Tay Sachs disease
Pervasive developmental disordersa group of disorders that are characterized by : impairments in social interaction, impairment in verbal and nonverbal communication, and a restrictive,stereotypic pattern of behaviours www.oafccd.com/factshee/fact59.htm
AutismAsperger’s Rett’s SyndromeChildhood disintegrative disorder
PDD-NOS
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-Impaired social interactions
-Social aloneness that is distinct from shyness
-Impaired communication, symbolic play
-Repetitive, stereotyped behaviorsexamples: hand flapping, turning, stacking objects
-Restricted interests and activities (singlemindedness)
-Lack of common sense
-Insistence on sameness
-Spotty intellectual achievements
-Difficulties with symbolization and abstraction
Characteristics of Autism (1)
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Characteristics of Autism (2)
-Delays present before age 3
-More prevalent in boys
-Often associated with mental retardation
-Associated with other disorders- notably epilepsy
-Diagnosis is based on behavioral tests!
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CriteriaCriteria
DSM-IV Criteria for Autistic DisorderDiagnostic and Statistical Manual of Mental Disorders, 4th edition,1994, Washington, DC: American Psychiatric Association, pp. 70-71.
A. A total of at least six items from (1), (2), and (3), withat least two from (1), and one each from (2) and (3):
(1) Qualitative impairment in social interaction, asmanifested by at least two of the following:(a) Marked impairment in the use of multiple
nonverbal behaviors such as eye-to-eye gaze,facial expression, body postures, and gestures toregulate social interaction;
(b) Failure to develop peer relationshipsappropriate to developmental level;
(c) Markedly impaired expression of pleasure inother peopleÕs happiness;
(d) Lack of social or emotional reciprocity.
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Criteria Contd…Criteria Contd…
DSM-IV Criteria for Autistic Disorder
(2) Qualitative impairments in communication asmanifested by at least one of the following:(a) Delay in, or total lack of, the development of
spoken language (not accompanied by an attemptto compensate through alternative modes ofcommunication such as gestures or mime);
(b) In individuals with adequate speech, markedimpairment in the ability to initiate or sustain aconversation with others;
(c) Stereotyped and repetitive use of language oridiosyncratic language;
(d) Lack of varied spontaneous make-believe play orsocial imitative play appropriate todevelopmental level.
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Criteria Contd..Criteria Contd..
DSM-IV Criteria for Autistic Disorder
(3) Restricted repetitive and stereotyped patterns ofbehavior, interests, and activities, as manifested by atleast one of the following:
(a) Encompassing preoccupation with one or morestereotyped and restricted patterns of interest thatis abnormal either in intensity or focus;
(b) Apparently compulsive adherence to specificnonfunctional routines or rituals;
(c) Stereotyped and repetitive motor mannerisms(e.g. hand or finger flapping or twisting, orcomplex whole-body movements);
(d) Persistent preoccupation with parts of objects.
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Criteria Contd…Criteria Contd…
DSM-IV Criteria for Autistic Disorder
B. Delays or abnormal functioning in at least one of thefollowing areas, with onset prior to age 3 years; (1)social interaction, (2) language as used in socialcommunication, or (3) symbolic or imaginative play.
C. Not better accounted for by RettÕs Disorder ofChildhood Disintegrative Disorder.
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A little history…
First reports: Leo Kanner (1943), Hans Asperger (1944)-Impairments in social interactions-Resistance to changes-Oversensitivity to some stimuli (sound)
Aspects of the original report that have been refuted-Parent were successful educationally or professionally-Problems relationships between parent and children
(Refrigerator mothers!)-Not related to other medical conditions-No mental retardation
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1950s- Autism is an early form of schizophrenia
-In 1971 Kolvin demonstrated a bimodal onset among a largegroup of ÒpsychoticÓ children- early onset in 1-2 years, lateronset after many years of normal behavior
-Early onset showed impairments in social, cognitive andlanguage (autism-like), no increased schizophrenia in families
-Later onset showed delusions, hallucinations and other featuresof schizophrenia
-Autism differed from schizophrenia in time of onset, clinicalfeatures, course, outcome and family history
A little history…
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Epidemiology of autism
-First epidemiological studies in England in the 1960s
-Since then more than 30 studies in many countries
-All have used a definition of autism that included severeimpairment in communication, language, socialinteractions, play and behavior
-BUT- the criteria for autism diagnosis has changed over time
-Studies range from 1966 to 2001
-In general smaller studies give higher prevalence
-Total number of children surveyed is around 5 million
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Epidemiology of autism
Rates of autism-Prevalence estimates range from 0.7/10,000 to 72.6/10,000-Prevalence rates higher with smaller sample size-average prevalence 10/10,000
Mental retardation-Assessment of intellectual function in 20/32 studies-30% showed no intellectual impairment (6.6-100%)
Gender-male/female sex ratio averaged 4.3 over all studies-Range 1.33 to 16-No study ever identified more girls than boys-Gender difference greater in non-mentally retarded subjects
5.75 to 1 in normal intellectual function group2:1 in groups with mental retardation
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Neuropathology
Increased head size
-Kanner described large heads in some children with autism
-Macrocephaly found in 20% of autistic individuals
-Not present in the first year of life
-Consistent with finding of increased brain weight
-Recent studies suggest that increases are transient (2-4 yrs)
-Neuroimaging has shown increased brain volume
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Schumann, C. M. et al. J. Neurosci. 2004;24:6392-6401
Figure 1. Orthogonal views for segmenting the amygdala and hippocampus on MRI
sections
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Controversies in autism
Causes of autism-Incidence-The role of the parent-Vaccines-Environmental toxins-Food allergies
Treatments for autism-Secretin-Diets-Facilitated communication-Drugs-Behavioral
Behavioral/Social issues-What distinguishes autism from other PDDs-Male/female differences-Mental retardation
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Bumps
into
people
in li
ne…
Difficulty with hair washing and brushing…
Overly sensitive to
loud noises…
Problems with handwriting…
Picky eater…Always “on the
go”…
Only likes certain types of clothing…
CHARACTERISTICS OF CHILDREN WITH AUTISM SPECTRUM CONDITIONS
Difficulty paying attention…
Clumsy…
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