AUTISM SPECTRUM DISORDERS DIAGNOSIS AND TREATMENT OPTIONS BY DR (MRS) E.A.E. ALUKO MB BS FWACP, DAAP.

AUTISM SPECTRUM DISORDERS DIAGNOSIS AND TREATMENT

OPTIONS

BY DR (MRS) E.A.E. ALUKO

MB BS FWACP, DAAP

Autism

• Defined as a Behavioral Disorder Characterized by Treatable Medical Problems

Autism• Impairments in communication• Problems with social interactions• Repetitive, restrictive or stereotyped

behaviors• Consider the concept of Autisms

Autism as a genetic syndrome

There are some classic genetic syndromes that are characterized by autistic behavior

William’s syndromeCri du ChatRett’s syndrome

BUT

Classic Genetics Cannot Explain Increased Illness In Children

• Increase Over the Past 20 Years- Autism: 6000% increase

* 1:1000 ---------- 1/50 * ADHD 400% increase

* Asthma 300% increase * Allergies 400% increase

Paradigm for understanding Autism

Genetic Susceptibilities

Environmental triggers Timing & Development

OVERVIEW

• Introduction• What are ASD• Who are the qualified professionals for

diagnostic assessments• Diagnostic criteria for medical diagram.

AUTISM SPECTRUM DISORDERS

• Developmental Disability not visible at birth• Different Brain Structure complex genetic interaction• Complex Disorder many areas affected• Wide Range of Impairment mild to severe across areas

ASD STATISTICS

• Estimates 1 in every 110 children for spectrum

• Present before the age of 3, but diagnosis often later

• Found in all cultures and economic groups• Four times more common in boys

3 AREAS AFFECTED

• Reciprocal Social Interactions• Communication• Behaviors and Interests - Development in these areas follows a

DIFFERENT path than that of most children - Differences are QUALITATIVE

ASDor

PDD

A SPECTRUM1.Asperger’s Disorder 2.Atypical Autism/PDD-NOS3.Austistic Disorder4.Rett’s Disorder5.Childhood Disintegrative Disorders

ASD DIAGNOSIS

• Based on observable behaviors no medical test to diagnose autism or

related disorders• Pattern of development• Social, Communication, Behavioral Profile• Developmental History Important• Rule out other Disorders

Delays or abnormal functioning in at least 1 of the following areas, with onset prior to age 3 years

*social interaction*language as used in social

communication*symbolic or imaginative play

DSM-1V CRITERIA : AUTISTIC DISORDER

• Qualitative impairment in reciprocal social interaction(2)

.marked impairment in use of multiple non verbal behaviors to regulate social

interactions.failure to develop peer relationships

appropriate to developmental level.a lack of spontaneous seeking to share

enjoyment, interests, or achievements with other people.lack of social or emotional reciprocity

Qualitative impairment in communication (1)*delay in, or total lack of, the development of

spoken language*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

*lack of varied, spontaneous make-believe play or social initiative play appropriate to developmental level

Restricted, repetitive, and stereotyped patterns of behavior, interests and activities

*encompassing preoccupations h 1 or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

*apparently inflexible adherence to specific, non functional routines or rituals

*persistent preoccupation with parts of objects

DSM-1V CRITERIA: ASPERGER’S DISORDER

*Qualitative impairment in reciprocal social interaction*Restricted, repetitive, and stereotyped patterns of

behavior, interests, and activities*There is no clinical significant general delay in language

.Single words by 2 yrs

.Communicative phrases by 3 yrs*There is no clinically significant delay in cognitive

development.Average or Above Average IQ score

DSM-1V CRITERIA: PDD-NOS

• Severe and pervasive impairment in development of social interaction

• Impairment in either .verbal or nonverbal communication skills

OR .with the presence of stereotyped behavior,

interests, and activities

DIAGNOSING AUTISM

FIRST STEPSCREENING

THEN

REFERRALFINALLY

EVALUATION AND DIAGNOSIS

EARLY DIAGNOSIS

LEADS TO

HIGH LEVELS OF

RECOVERY

SCREENING FOR ASD

*Child ideally younger than 3years*Best done between ages 12mnths-24mnths

Done on 2 levelsLevel 1

Primary caregiver reports Numerous screening forms exist CHAT ESAT CSBS

M-CHATPlease fill out the following about how your child usually is. Please try to answer every question. If the behavior is rare (e.g..you’ve seen it once or twice),please answer as if the child does not do it.1. Does your child enjoy being swung, bounced on your knee, etc.? Yes No2. Does your child take an interest in other children? Yes No3. Does your child like climbing on things such as up stairs? Yes No4. Does your child enjoy playing peek-a boo/hide-and-seek? Yes No5. Does your child ever pretend, for example, to talk on the phone or take care of a doll or pretend other things?

Yes No6. Does your child ever use his/her index finger to point, to ask for something? Yes No

M-CHAT (cont)7. Does your child ever use his/her index finger to point, to indicate interest in something?

Yes No8. Can your child play properly with small toys (e.g. cars or blocks) without just mouthing, fiddling, or dropping them? Yes No9. Does your child ever bring objects over to you (parent) to show you something? Yes No10. Does your child look you in the eye for more than a second or two? Yes No11. Does your child ever seem over sensitive to

noise? (e.g.. Plugging ears) Yes No

M-CHAT (CONT)12. Does your child smile in response to your face or your smile? Yes No13. Does your child imitate you? (e.g..you make a face-will your child imitate it?) Yes No14. Does your child respond to his/her name when you call? Yes No15. If you point a toy across the room, does your child look at it? Yes No16. Does your child walk? Yes No17. Does your child look at things you are looking at? Yes No18. Does your child make unusual finger movements near his or her face? Yes No

M-CHAT (CONT.)19. Does your child try to attract your attention to his/her own activity? Yes No20. Have you ever wondered if your child is deaf? Yes No21. Does your child understand what people say? Yes No23. Does your child look at your face to check your reaction when faced with something unfamiliar? Yes No

• LEVEL 2

• PROFESSIONAL REPORTS• FOCUSED ON BEHAVIOR

• CSBC • PDDST• STAT• CARS (Childhood Autism Rating Scale)

• CARS most commonly used tool by professionals

COLLATION OF ALL INFORMATION if suggestive

RERRERAL FOR EVALUATION

WHO IS QUALIFIED TO MAKE AN ASD DIAGNOSIS?

*Due to complexities in diagnosis relating to range of behaviors various professionals are needed.

* MULTIDISCIPLINARY TEAM

MULTIDISCIPLINARY TEAM

• Special educators• General educators• Psychologists• Speech-language pathologists• Occupational therapists• Physical therapists• Physician(e.g., neurologist, pediatrician)

Multidisciplinary team should be supervised by one of the following ;

*Licensed Clinical Psychologist*Licensed Physician/Pediatrician*School psychologist

DIAGNOSING ASDs

*Developmental history is important*Rule out other disorders

DIAGNOSIS

Evaluation andGOLD STANDARD ASSESMENTS

STATE-OF-THE-ART (Gold Standard assessments)EVALUATION FOR ASD

• Medical examination• Parent interview (ADI-R)• Individual observation (ADOS by

Professionals) • Developmental language testing

MEDICAL EXAMINATION

*Physical examination*Rule out hearing / vision impairments*Genetic Testing*Neurological Examination

PARENT INTERVIEW ADI-R

*Developmental history*Semi-structured interview about social skills*Communication*Behaviors and

*Adaptive skills

ADI-R (Physician administered)Extensive Primary Caregiver Interview (93items)

* Early Development (7)*Acquisition and Loss of Language/Other Skills (20)*Language and Communication Functioning (21)*Social Development and Play (10)*Favorite Activities and Toys (7)*Interests and Behaviors (13)*General Behaviors (13)

AUTISM DIAGNOSTIC OBSERVATION SCHEDULE(ADOS)

*Play/Interview-based assessment*Five modules

.Toddler (12-30months)

.Preverbal/single words

.Phrase speech

.Fluent speech: Child/Adolescent

.Fluent speech: Adolescent/Adult

NOW THAT I HAVE A DIAGNOSIS…..

*Opportunity to educate physicians, teachers, community providers about

.Diagnostic resources

.Early signs

.Referrals for intervention*Be On Same Page

.Everyone in life

.Follow-up diagnosis?*Start services and treatment

WHAT SERVICES SHOULD MY CHILD RECEIVE?

* Services should be based on .3 main domains associated with ASD’S

- Social interactions- Communication- Behaviors and Interests

.Those specific challenges of ASD that face your child- ASD is not a one-size-fits-all- Should be tailored to those ASD criteria your child meets

SERVICES SHOULD *Promote independence and social responsibility*Ameliorate behavioral difficulties*Promote generalization across multiple

environments*IFSP/IEP/ISP vehicle for planning and

implementing objectives and benchmarks.Observables.Moderate behaviors and skills.Achievable within 1 year.Expect to affect participation in

-Education -Community

-Family life

SERVICES (CONT.)

*Social skills.Imitate others.Social initiations to others.Response to adults AND peers

-Needs access to typical peers.Parallel and interactive play with peers and

siblings*Communication

.Expressive verbal language

.Repetitive language

.Nonverbal communications skills

.Functional symbolic communication system

SERVICES SHOULD (CONT.)*Increase engagement and flexibility in developmentally appropriate activities and play*Attend to the environment*Respond to appropriate motivational system*Motor skills

.Fine and gross

.Age appropriate functional activities*Cognitive skills

.Symbolic play

.Basic concepts

.Academic skills

SERVICES SHOULD (CONT.)

*Replace problem behaviors.More conventional and appropriate

behaviors*Increase independent organizational skills

.Success in general education classrooms*Include parents and families as meaningful team

members – They are experts on their child*Be consistent across settings

.Home, school, community.

CONCLUSIONS

• Diagnosis of ASD is a label that can get services

• Label assists others to know what skills are areas of strengths and which are areas of needs

• No two individuals with ASD are alike• Services should be tailored to individual’s

strengths and needs

THANK YOU

DR (MRS) E.A.E. ALUKO

MB BS FWACP, DAAP