-
The New Face of AutismReconceptualizing the Symptoms and
Impairments in Autism Spectrum DisordersSam Goldstein Ph.D.
Assistant Clinical Professor of Psychiatry University of Utah
Affiliate Research Professor of Psychology George Mason
University
www.samgoldstein.com
-
GoalsBriefly discuss the historical theories of Autism Spectrum
Disorders (ASD).Define ASD.Briefly discuss syptoms of ASD by
age.Briefly discuss a core theory of ASD.Briefly review
hypothesized causes.Introduce data from the largest epidemiological
sample collected of normal children and those with ASD.
-
Kanners Description (1943)Inability to relate in ordinary ways
to people.Disinterest in parents and people.Excellent rote memory
skills.Language difficulties including but not limited to: mutism,
echolalia, pronoun reversal, literalness, poor social language.Lack
of spontaneous activity.A wide range of cognitive skills.
-
Kanners Description (1943)Self absorbed facination with the
inanimate environment.Pronounced resistance to change in
routine.Purposeless repetitive movements.Isolated interest and
proficiency in meaningless tasks with endless repetition.
-
Gillbergs DescriptionImpaired social interaction.Self absorbed
behavior.Odd interests and routines.Speech and language problems
inspite of seemingly competent superficial language
skills.Non-verbal communication problems.Motor clumsiness.
-
Autism is increasingly referred to as a spectrum disorder in
which individuals can present problems ranging from total
impairment to near reasonable functioning.
-
In the DSM model Autism Spectrum Disorder (ASD) is referred to
as the Pervasive Developmental Disorders (PDD)s.
-
The Pervasive Developmental Disorders (PDDs) are a group of
conditions that share certain clinical features but appear to have
diverse etiologies and natural courses.
-
The term PDD emphasizes the pervasiveness of disturbances over a
wide range of different domains affecting the normal unfolding and
development of multiple competencies.
-
PDDsOnset in infancy or early childhood.Typical patterns of
delays and deviance in social, affective and communicative
development.Expanding recognition and interest in the clinical and
educational realms.Spectrum, continuum or syndrome?
-
Core DSM and ICD Autistic SymptomsImpaired social
relations.Impaired communication skills.Impaired behavior.
-
The social development of autistic children is qualitatively
different from other children.
-
In normal children perceptual, affective and neuroregulatory
mechanisms predispose young infants to engage in social interaction
from very early on in their lives.
-
Young autistic children:
Have little interest in the human face.Lack differential
preference for speech sounds.Lack imitative capacity.Lack interest
in physical comfort.Dont attach to caretakers well.
-
Symptoms Present Before 24 Months: Failure To -Orient to
nameAttend to human voiceLook at face and eyes of othersImitateShow
objectsPointDemonstrate interest in other children
-
Symptoms Present Before 36 MonthsUse of others body to
communicate or as a toolStereotyped hand/finger/body
mannerismsRitualistic behaviorFailure to demonstrate pretend
playFailure to demonstrate joint attention
-
Joint AttentionBehaviors that focus the attention of the self
and others on the same object (e.g. pointing,sharing emotion,
etc.)Develops between 6 and 9 monthsPrecursor of more advanced
social and communication skills
-
Joint AttentionThis abnormality thought to be one of the
earliest signs of autismPresent in children with developmental
delays absent autismThis ability when present in preschoolers with
autism predicts better prognosis for language development
-
Pretend Play in AutismLimited, often absentWhen present usually
characterized by: repetitive themes, rigidity, isolated acts,
one-sided play, limited imagination.
-
Theory of MindA new line of research has proposed that the
social deficits in autism represent a specific, innate cognitive
capacity to attribute mental states to others and oneself and use
these to explain and predict another persons behavior.
-
One in four autistic children experience physical problems
including epilepsy.
-
Up to eighty percent of autistic children experience
intellectual deficits.
-
Level of cognitive functioning and useful language by five years
of age are the best predictors of outcome.
-
Autism occurs at a greater than chance rate with:
Fragile XTuberous sclerosisNeurofibromatosisWilliams
syndromePhenylketonuriaCongenital rubella
-
Idiopathic Autism90% of cases.Genetics plays an important
role.Autism occurs more frequently in monozygotic than dizygotic
twins.The rate of autism among siblings is significantly higher
than the general population.No single causative gene has been
identified.At least five or more genes interact.Genes on
chromosomes 7 and 15 look promising.
-
The Autism Spectrum Rating Scale Project (Goldstein and
Naglieri)A normative look at autistic symptoms, behaviors and
impairments,
-
ASRS Data Collection ProcedureSite coordinators from across the
U.S. collected data between October 2006 and October 2008.Over
5,000 children were sampled at home and at school.
Normative data was stratified to match the U.S. Census on
race/ethnicity, parental education level, and geographic
location.
Standard procedures were followed:informed consent
obtainedspecific instructions given to ratersraters debriefed upon
completion
-
ASRS Standardization Samples
-
ASRS StructureDSM-IV-TR AlgorithmValidity ScalesPositive
ImpressionNegative ImpressionInconsistency IndexTreatment
ScalesPeer SocializationAdult SocializationSocial/Emotional
ReciprocityAtypical LanguageStereotypyBehavioral RigiditySensory
SensitivityAttention
-
Sample Items: ASRS ScalesPrincipal Axis Factoring with Direct
Oblimin rotation.
-
Classification AccuracyClassification accuracy (predicting ASD
vs. General Population group membership) of responses on the ASRS
Parent (6-18).
-
Important ConclusionsAutism Spectrum Disorder represents a
unique, measurable condition distinct from normal behavior and
development.DSM-IV requires revision.ASD is best represented by a 3
factor model with associated symptoms and behaviors.
-
www.samgoldstein.comwww.raisingresilientkids.cominfo@samgoldstein.com
Discriminant Function Analyses (DFA) were conducted in order to
determine if scores on the ASRS could accurately predict group
membership into the ASD or matched general population group (gen
pop group matched to ASD group on age, gender, and race/ethnicity).
The grouping variable in all DFAs was the actual group membership
of the respondent. The predictors included the ASRS scales. N for
each group was 80.
Overall correct classification rate: the percentage or
proportion of correct classifications.Sensitivity: the ability of
the ASRS scores to correctly detect clinical cases in a population
(i.e., the proportion of target clinical youth predicted to belong
to this group by the ASRS).Specificity: the ability of the ASRS to
correctly identify general population cases (i.e., the proportion
of general population youth predicted to belong to the general
population group).PositivePredictive power (PPP): the percentage of
youth identified by the ASRS as having a disorder who, in fact,
have that disorder. NegativePredictive power (NPP): the percentage
of youth identified by the ASRS as not having a disorder who, in
fact, do not have that disorder. FalsePositive rate: the percentage
of youth identified as having a disorder who, in fact, do not have
the disorder.False-negative rate: the percentage of youth
identified as not having a disorder who, in fact, do have that
disorder.