Autism Spectrum Disorder

• 1. AUTISM SPECTRUM DISORDER Georgina Peacock, MD, MPH, FAAP GCAN December 5, 2013

2. Autism Autism first described by psychiatrist Leo Kanner in 1943 in the US Hans Asperger described autistic psychopathology in 1944 in Austria (work later translated in the 1980s to recognize Asperger syndrome) Autism was once seen as a rare conditionLearn the Signs. Act Early.www.cdc.gov/actearly 3. About 4 million babies born in the US each year 1 in 6 children will have a developmental disability 1 in 88 with autism*(Boyle et al., 2011; CDC, 2012)* Autism Spectrum Disorders (ASDs) 4. Public Health Concern Children with autism or developmental delays are at increased risk for poor outcomes Early intervention can significantly impact acquisition of important lifeskills Many children with developmental disabilities are not identified until kindergarten or later Only 30% of children with DD identified before Kindergarten (Palfrey, 1987) Only 18% of children with ASD identified by age 3 years (CDC, ADDM 2012) Children from low income and/or minority families experience longer delays in receiving services 5. 19 month old twins 6. Autism Developmental disability Complex disorder Not recognizable at birth Typically lifelongMany areas affectedWide range of impairment Mild to severe across areasLearn the Signs. Act Early.www.cdc.gov/actearly 7. ASD Characteristics Vary Social Interaction Aloof-----------------Passive-------------Active but oddCommunication Nonverbal----------------------------------------------VerbalBehaviors Intense-----------------------------------------------------MildMeasured Intelligence Severe---------------------------------------------------GiftedAdaptive Functioning Low-------------------------Variable----------High in areas 8. Pervasive Developmental Disorders (PDDs) to Autism Spectrum Disorder (ASD)DSM-IV,TR 1994, 2000DSM-5May 2013Pervasive Developmental Disorders:Autistic disorder Aspergers PDD-NOSAutism Spectrum DisorderRetts CDDDiagnostic and Statistical Manual (DSM), American Psychiatric Association 9. Changes from DSM-IV to DSM-5 DSM-IVDSM-5 10. Autism Spectrum Disorder 299.0 (ICD10 F84) A. Persistent deficits in social communication and interactions 1. Social-emotional reciprocity 2. Nonverbal communication behaviors used for social interactions; 3. Developing, maintaining, and understanding relationships 11. Autism Spectrum Disorder 299.0 continued B. Restricted, repetitive patterns of behavior, interests, and activities (at least TWO of the following): 1. Stereotyped or repetitive motor movements, use of objects, or speech 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior 3. Highly restricted, fixated interests 4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment 12. Autism Spectrum Disorder 299.0 continued C. Symptoms must be present in the early developmental period (but may not become fully recognized until social demands exceed limited capacities) D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning 13. Diagnostic challenges ASD may be diagnosed with other overlapping disorders such as ADHD, Language ImpairmentsLanguage DisordersLearning DisabilitiesADHDIntellectual DisabilityASDAnxietyEtcADOS-2 trainers slides 14. What happens to my childs diagnosis? Was the dx wrong? Do we need to go through the diagnostic process again? Will services change? What happens to me? I am an Aspie! Do I have to go through more evaluation? Will services change?People with AutismFamilies How does this change my practice? How to I learn the new concepts? New training, tools ($)? How will I define my samples? Comparability? Is this valid and reliable? Impact on research funding? What does this mean for current policies and laws? What are the costs? Personnel needs?Clinical and Educational ProfessionalsResearchersPolicy Makers 15. Autism Spectrum DisorderROLE FOR EARLY IDENTIFICATION 16. (CDC, 2012) Most children identified with ASD had a developmental concern documented in their evaluation records before the age of 2 years, but Diagnosis often not until after age 4 years 82% of children with ASD did not have a diagnosis by age 3 years 21% of children with ASD did not have a diagnosis by age 8 years Significant lag exists between concern and diagnosis 17. Learn the Signs. Act Early. Goal: To improve early identification of autism and other developmental disabilities so children and their families can get the services and support they need 18. Learn the Signs. Act Early. Learn the Signs: Resources for monitoring key developmental milestones among ALL children Red flags that can indicate concern Act Early: Discuss Concerns Proactive Screening Refer for evaluation and services Find resources for early intervention and family support 19. Well-child visits for ALL children should include: Developmental Screening Use of a validated screening tool at 9, 18, 24 or 30 monthsASD-specific screening 18 and 24 or 30 months If concern identified: 1. Refer for intervention 2. Refer for evaluation AAP Policy Statement (2006) 20. % Reported Developmental Monitoring and/or ScreeningMonitoring ONLY 36.9 42.0Monitoring AND Screening Screening ONLY Neither5.715.4National Survey of Childrens Health (NSCH) 2007; ages 10-47 monthsPreliminary results, not for 21. Acknowledgements Catherine Rice Learn the Signs. Act Early Team 22. Thank you! Georgina Peacock [email protected] 23. New Diagnosis = Social (Pragmatic) Communication Disorder A Communication Disorder Impairments in use of social communication No Restricted and Repetitive Behaviors like ASD How is SCD similar and different from Pragmatic Language Disorder, Nonverbal Learning Disability, and PDD-NOS?