Autism Spectrum Disorders Workshop for SPALS

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Autism Spectrum Disorders

Workshop for SPALSBaton Rouge, LASeptember 2003

Glenis Benson, Ph.D.

Today’s Agenda

• Fundamentals• Early Identification• Characteristics• Interventions

Pervasive Developmental Disorders (PDD)

= Autism Spectrum Disorder (ASD)

• pattern of deficits in communication, socialization and behaviors and interests

Pervasive Developmental Disorders(Diagnostic and Statistical Manual DSM-IV, APA 1994)

• Autistic Disorder• Asperger’s Disorder• Rett’s Disorder• Childhood Disintegrative Disorder• Pervasive Developmental Disorder-Not

Otherwise Specified

Pervasive Developmental Disorders

(Diagnostic and Statistical Manual, DSM-IV, APA 1994)

• Autistic Disorder• Asperger’s Disorder• Rett’s Disorder• Childhood Disintegrative Disorder• Pervasive Developmental Disorder-Not

Otherwise Specified

Diagnostic Criteria for Autistic Disorder(DSM-IV, APA 1994)

• qualitative impairment in social interaction• qualitative impairments in communication• restricted repetitive and stereotyped

patterns of behavior, interests and activities

• onset prior to 3 years of age

-Qualitative impairment in social interaction marked impairment in the use of multiple

nonverbal 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 a lack of showing, bringing, or pointing out objects of interest)

lack of social or emotional reciprocity

-Qualitative impairment in communication

• 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 conversation with others

• stereotyped and repetitive use of language or idiosyncratic language

• lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

-Restricted repetitive and stereotyped patterns, interests,and activities, as manifested by at least one 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)

• persistent preoccupation with parts of objects

Autistic Disorder

• impairments in:– socialization,– communication, and – behaviors / interests

• at least two signs from social, and one sign from each communicative, and behavior/interests

• must meet 6 or more criteria

Asperger’s Disorder:

• impairments in:- socialization, described as “active, but odd”- one or more areas of narrow, circumscribed

interest• no, or only mild delays in language

- single words by 2 years of age, phrases by 3• no significant delay in cognitive

development or adaptive behaviors

PDD-NOS (Pervasive Developmental

Disorder-Not Otherwise Specified)

• implies the presence of fewer, and at times less severe signs of autism

• can be thought of as a milder form of autism• “those meeting fewer criteria are

diagnosable as PDD-NOS”• the lower limit is not clearly specified• sometimes called ‘atypical autism’

Autism Spectrum Disorders constitute a SYNDROME

• affected individuals will not have ALL the associated signs and symptoms

• therefore no two persons with autism are alike! (no different from no two neurotypicals being alike)

• many different causes, resulting in an overlapping set of symptoms

Cognitive ability(Fonbonne, 1999)

• 75-80% are dually diagnosed with mental retardation

• only 20-25% have IQs>70• girls are more likely to have mental

retardation

Communicative ability

• 50% remain nonverbal• 85% of talkers once were echolalic• fairly good language skills before 5 or 6

years of age are indicative of intellectual/social competence later in life

Social ability

• desirous, but inept/awkward• appear aloof

Seizure disorder:

• 25%-33% will develop seizure disorder (Bristol, 1996, Kanner, 2000, Tuchman, 2000)

How common are Autism Spectrum Disorders

combined?

• 3/500 (current epidemiological-Baird et al, 2000, Chakrabarti & Fonbonne, 2001)

• 3-4/1000 (or 1.5-2/500) Yeargin-Allsopp, 2003)

In relation to other disabilities...

• At this rate ASDS are:– 5X more common than Down

Syndrome– 3X more common than juvenile

diabetes

In Louisiana there should be 26,895 people

with a disorder on the Autism Spectrum

Epidemic anyone????

• Under diagnosed in the 70’s• Criteria have been consistent for some time• Addition of Asperger’s in 1994• Prevalence of PDD-NOS diagnosis• Far better diagnostics• Diagnostic tool meshes with diagnostic criteria• Professionals no longer ‘avoid’ the diagnosis

Male to Female Ratio(Fonbonne, 1999)

• see more boys than girls, – 3-4/1 for Autism– 10/1 for Aspergers

• ratio indicative of a biological origin

Do we know what causes Autism?

• usually it is impossible to demonstrate WHAT caused Autism in a particular child

Vaccinations (MMR jab)

• “flavor of the month”• VERY controversial• numerous studies show NO RELATION

(Fonbonne & Chakrabarti, 2001; Madsen et al, 2002; Taylor et al. 2002)

Well then what about thimerosal, or mercury-containing vaccines?

• Evidence for a CAUSAL association for autism is weak (Stratton et al., 2001; Pichiechero et al, 2002)

Why do people think vaccines?

• numbered heads for 6 groups• As a team, develop a question to ask

another group

• Write that question on a piece of paper

For a substantial subset, autism

hasgenetic

involvement..It’s in the genes

Genetics of Autism

• Bauman (2002)“It is a complicated disorder.” “It is likely

that there is more than one gene involved, but there is no consensus on the gene or genes … studies continue on genetic vulnerability,”

• Whether this is primarily a genetic disorder or a genetic vulnerability for other external factors remains to be determined.

• Autism is a behavioral manifestation of various brain abnormalities that likely develop as a result of a combination of genetic predispositions and early environmental (probably in utero) insults.

• (Herbert, Sharp & Gaudiano, 2002)

No empirical support for:

• Unloving mothers• yeast infections• childhood vaccinations

What we know:

• Acceleration then deceleration in brain growth (many areas have increased volume)

• Increased neuronal packing and decreased cell size in the limbic system

• enlarged amygdala• fusiform facial gyrus is not activated by facial

information

Functional and structural abnormalities• Amygdala (important for emotion and

behavior)– recognition of affect/emotions/faces, perception

of body movements, eye gaze direction, orienting to social stimuli, understanding stimulus-reward associations

• Hippocampus (memory and learning)– hyperactivity, disordered responses to new

situations, and stereotypic mannerisms

What role do medications have in the treatment of autism?

• none have been found to treat autism as a whole

• medications can treat symptoms only• no pharmacologic agents with FDA-

approved labeling for autism

History of Diagnoses

• autism was described by Kanner in 1943• not in the DSM until DSM-III in 1980

– narrow definition that focused on younger, more impaired

• DSM-III-R in 1987– definition was more inclusive

• Asperger’s added in DSM-IV in 1994• 20 years later and we discuss an ‘increase’

Diagnosis will vary according to the

knowledge base and analytical prowess of

the diagnostician

No one thing can make or break a diagnosis!

• E.g., sense of humour, physically affectionate