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Foundations of Autism (Autism Spectrum Disorder)

Jan 27, 2016




Foundations of Autism (Autism Spectrum Disorder). Steven M. Graff, Ph.D. Director of Clinical Services Tri-Counties Regional Center & Laura D. Valdez, M.S. Camarillo Academy for Excellence November 3, 2012. Clinical Definitions. - PowerPoint PPT Presentation

  • Foundations of Autism(Autism Spectrum Disorder)Steven M. Graff, Ph.D.Director of Clinical ServicesTri-Counties Regional Center&Laura D. Valdez, M.S.Camarillo Academy for ExcellenceNovember 3, 2012

  • Clinical DefinitionsDiagnostic and Statistical Manual (DSM-IV-TR): Autism, Asperger syndrome, and Pervasive developmental disorder NOS are discrete disordersThey will be combined and called ASD with level of severity specified in the new DSM-5..Federal Educational CodeA wide variety of problems can earn the same eligibility: autistic/autistic-like

  • Presentations of Classic AutismBirth to 24 months: feeding problems; failure to thrive; poor latch and suck; arching back; colic; problems sleeping; poor eye contact; not responding to name; loss of previously acquired language.

    Why does this get missed? (Subtle oddities; first child; families moving away from grandparents & family?)

  • Presentations of Late Onset3 to 5 years old:Jargon, echolalia, scripted language; lack of imaginative play, fascination with cause-and-effect toys, lights, mirrors or fans; odd or perseverative interests; lack of interest in others, especially children (no parallel or interactive play); severe tantrums (>60)

  • Other Disorders That Are Commonly Mistaken For AutismFragile X syndromeTuberous SclerosisBipolar DisorderLandau-Kleffner Syn.Tourettes Syn.Fetal Alcohol Syn. (FAS)Epileptic aphasiaAsperger Syn.Pervasive developmental disorder NOS

    Communication DisordersNeurofibromatosisIntellectual Disability (Mental Retardation)Severe Abuse or NeglectADHDObsessive Compulsive DisorderSocial communication disorderChildhood disintegrative disorderRhetts disorder

  • Myths of Persons with Autism

    Do not care about othersDo not feel emotionsDo not feel painDo not want relationshipsAll are savant geniuses

  • Epigenetics: interaction between environmental exposure and genetic material

    Genetic predisposition EXTREMELY LIKELY[over 60 genes identified so far and increasing] +Environmental exposure: pesticides heavy metal pollutants; air pollutants; bisphenyl A [plastics], flame retardants; and viruses

    Vaccinations are not a cause according to most scientific research

  • Theory of mind and Mirror Neurons

    Ever wondered how some people can put themselves into another person's shoes and some people cannot? Our ability to empathize with others seems to depend on the action of "mirror neurons" in the brain, Mirror neurons activate when an action is observed, and also when it is performed. Research reveals that there are mirror neurons in humans that fire when sounds are heard. In other words, if you hear the noise of someone eating an apple, some of the same neurons fire as when you eat the apple yourself. Subjects in the study who scored higher in empathy tests also showed higher levels of mirror neuron activation. (Gazzola, 2006)

    Persons with autism seem to lack this Mirror system.

  • More thoughts on symptom causation: Reticular activating system (the brains alarm clock is often hyper developed, leading to sleep disorders which can lead to behavior problems!

    Higher incidence of allergies and sensitivities, leading to sinus headaches and diarrhea, which lead to behavior problems!

    Left supra orbital frontal cortex (social awareness center) is underdeveloped-no Theory of Mind (T.O.M.) which leads to social problems

    Dopaminergic pathways tend to be underdeveloped, leading to emotional dysregulation which leads to behavior problems!

  • BrainStructure and organization of the brain is often different than control studies.

    Often see microcephaly at birth; yet macrocephaly at first year check up (too rapid brain growth without apoptosis, or normal death of unneeded cells).

    Cerebellum: Punkinje (nourishment) cells-decreased number.

    Limbic System and Cortex-decreased neuron density.

    Dendridic interconnectivity odd everywhere.

  • EmbryologyAutism starts in the first trimester [Thalidomide; viral infection history] in the gastrula stage, when the neural plate is forming the neural tube. Normal axon migration is disrupted-cells going in the wrong direction, with too few/too many cells in nerve tracts, and poor connectivity of synapses

  • Red Flag IndicatorsNO babbling by 12 monthsLack of response to name at 12 monthsNO back and forth gestures such as pointing, showing, reaching, or wavingNO meaningful words by 16 monthsNO 2-way meaningful phrases by 24 months of age (excluding imitation)ANY loss of speech, babbling, or social skills at ANY age (but remember, new siblings often bring loss of adaptive skills for a while in typical kids)

  • How do we diagnosis Autism?

  • Interdisciplinary Team [IDT] is Best PracticeAn IDT approach allows you to evaluate and integrate the effects of ASD on multiple areas of the childs development and provide a comprehensive profile of the child

  • Domains of ObservationReciprocal turn takingSocial reciprocitySustained interactionSpontaneous giving/showingImitation of novel actsShared attentionPretend PlayGaze aversionAbility to have examiner direct attentionUse of toys and objects

  • Cognitive Assessment

    A careful examination of cognitive functioning is needed to plan meaningful interventionsCognitive functioning is measured more accurately using a combination of formal and informal observational methods.The assessment of young children with suspected ASD requires knowledge of both normal child development as well as the developmental issues of persons with autism.

  • Adaptive FunctioningAdaptive functioning refers to the childs ability to use acquired skills and abilities to cope with the demands of daily living.Measures of adaptive functioning are required to render a formal diagnosis of mental retardation concomitant with ASD as well as determine a baseline of acquired skills for ASD or other differential diagnosis.Children with ASD often display discrepancies in certain facets of cognitive abilities and adaptive functioning levels.

  • Social DeficitsDeficits of interactivityPoor eye contactFlat/inappropriate facial expressionPoor non-verbal social skillsLack of empathy or blunted emotional responsesDelayed or absent peer relationshipsDelayed or absent interest in others

  • Socialization StylesAloof-often described as being in his own world

    Passive-which can be ignored if not a problem in the classroom

    Interactive but odd

  • CommunicationSevere delay or absence of useful speech/nonverbal communication.Receptive language skill level often different than expressive skill level.Use of evasive language is common.Parent anticipation of communicative intent/ using parents as tools

  • Communication Cont.Echolalia, delayed echolaliaJargon, idiosyncratic wordsScripted speech [TV, movies]Prosody/pragmatics of speech Pronoun reversal

  • BehaviorStereotypic motor movements and perseverationsHand flapping, spinning, finger play, fixation on themes, colors, numbers, people, objects. [must differentiate between party behavior vs. true oddities]-not toe walking-very common in all children.

  • Behavior Cont.Difficulty with transitions Routines, rituals, difficulties when they are disrupted even from highly non-preferred activitiesNeed for task completion or closure

    Fixation with parts (wheels) versus whole (car)

  • Sensory DifferencesIt is likely there is a continuum of visual and auditory processing problems for most people with autism, which goes from fractured, disjointed images at one end to a slight abnormality at the other end.

    Temple Grandin, Thinking in Pictures

  • Hyper/Hypo-sensitivities (increased/decreased)Sound






  • Hyper/Hypo-sensitivitiesThey can co-exist:How come his pain tolerance is so high yet he cant stand to be touched?Why does he act like hes deaf, yet is bothered by the buzzing of the lights in the classroom?

  • Learning and Thinking in AutismVisual Learners mostly, but not always.

    Auditory learning with comprehension is not usually a strength (but mimicry is)

    Often Kinesthetic learners (need motoring through; cant be told how to do it)

    Concrete thinkers, not abstract

  • A child with autism may look like..Uneven pattern of development

    Rote memory a relative strength, but analysis and inference are weaknesses

    Visual procession of information a relative strength

    Communication/social interactions highly problematic

  • A child with autism may also look likeGeneralization of knowledge/skills is difficultSkills available spontaneously, but not on requestResistance to change/desire for sameness can be problematicAttention difficultiesSensory differences

  • Three Mainstream Treatment ApproachesIntensive Behavioral Interventions-IBIDiscrete Trial Training (DTT), Applied Behavioral Analysis (ABA), Lovaas and Pivotal Response Therapy (PRT)

    Treatment & Education of Autistic & Communicationally Handicapped Children (TEACCH)

    Developmental: Greenspan/Floor time, DIR-individual difference, relationship-based model

  • Individuals with Disabilities Education ActThe IDEA mandates that all children with disabilities receive a free, appropriate public education in the least restrictive environment, tailored to each childs individual needs.

  • Educational Needs of Persons with AutismPreschool AgeCommunication therapies in the classroom and at home. (group and individual)Parent participation and training1:1 as well as small group instructionChild engaged in a variety of developmentally approp