Manovikasindia.org.in Dr. Alok Post Box: 9540, Delhi-110095, India [email protected] AUTISM.

manovikasindia.org.in

Dr. Alok

Post Box: 9540, Delhi-110095, India

[email protected]

AUTISM AUTISM

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Facts. . .Facts. . .

AutismAutismGeneticGenetic

Environmental Environmental FactorsFactors

Personal Personal FactorsFactors

Body Function & Body Function & StructureStructure

Brain structures, Brain structures, neurotransmitters, sensory neurotransmitters, sensory

processingprocessing

ActivitiesActivitiesPlay skills,Play skills,

Social skills,Social skills,Communication skills,Communication skills,

BehaviorBehavior

ParticipationParticipationRecreation/Leisure,

Relationship, education

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DefinitionDefinition

AutismA spectrum of neuropsychiatric disorders characterized by deficits in social interaction and communication, and unusual and repetitive behavior.

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What is AutismWhat is Autism

Autism is a Pervasive Developmental Disorder (PDD)

Who, what, when where why?

The human brain-normal and abnormal development

Genetics

Language and cognition

Social implications

Interventions and therapies

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What is developmental What is developmental disorder/disabilitydisorder/disability

Birth defects Developmental Disabilities-Cerebral palsy-Down’s syndrome-Learning disabilities and ADHD-Autism and PDDs

-Spina bifida-Heart defects-Cleft palate/club foot-Tay Sachs disease

Pervasive developmental disordersa group of disorders that are characterized by : impairments in social interaction, impairment in verbal and nonverbal communication, and a restrictive,stereotypic pattern of behaviours www.oafccd.com/factshee/fact59.htm

AutismAsperger’s Rett’s SyndromeChildhood disintegrative disorder

PDD-NOS

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-Impaired social interactions

-Social aloneness that is distinct from shyness

-Impaired communication, symbolic play

-Repetitive, stereotyped behaviorsexamples: hand flapping, turning, stacking objects

-Restricted interests and activities (singlemindedness)

-Lack of common sense

-Insistence on sameness

-Spotty intellectual achievements

-Difficulties with symbolization and abstraction

Characteristics of Autism (1)

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Characteristics of Autism (2)

-Delays present before age 3

-More prevalent in boys

-Often associated with mental retardation

-Associated with other disorders- notably epilepsy

-Diagnosis is based on behavioral tests!

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CriteriaCriteria

DSM-IV Criteria for Autistic DisorderDiagnostic and Statistical Manual of Mental Disorders, 4th edition,1994, Washington, DC: American Psychiatric Association, pp. 70-71.

A. A total of at least six items from (1), (2), and (3), withat least two from (1), and one each from (2) and (3):

(1) Qualitative impairment in social interaction, asmanifested by at least two of the following:(a) Marked impairment in the use of multiple

nonverbal behaviors such as eye-to-eye gaze,facial expression, body postures, and gestures toregulate social interaction;

(b) Failure to develop peer relationshipsappropriate to developmental level;

(c) Markedly impaired expression of pleasure inother peopleÕs happiness;

(d) Lack of social or emotional reciprocity.

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Criteria Contd…Criteria Contd…

DSM-IV Criteria for Autistic Disorder

(2) Qualitative impairments in communication asmanifested by at least one of the following:(a) Delay in, or total lack of, the development of

spoken language (not accompanied by an attemptto compensate through alternative modes ofcommunication such as gestures or mime);

(b) In individuals with adequate speech, markedimpairment in the ability to initiate or sustain aconversation with others;

(c) Stereotyped and repetitive use of language oridiosyncratic language;

(d) Lack of varied spontaneous make-believe play orsocial imitative play appropriate todevelopmental level.

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Criteria Contd..Criteria Contd..

DSM-IV Criteria for Autistic Disorder

(3) Restricted repetitive and stereotyped patterns ofbehavior, interests, and activities, as manifested by atleast one of the following:

(a) Encompassing preoccupation with one or morestereotyped and restricted patterns of interest thatis abnormal either in intensity or focus;

(b) Apparently compulsive adherence to specificnonfunctional routines or rituals;

(c) Stereotyped and repetitive motor mannerisms(e.g. hand or finger flapping or twisting, orcomplex whole-body movements);

(d) Persistent preoccupation with parts of objects.

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Criteria Contd…Criteria Contd…

DSM-IV Criteria for Autistic Disorder

B. Delays or abnormal functioning in at least one of thefollowing areas, with onset prior to age 3 years; (1)social interaction, (2) language as used in socialcommunication, or (3) symbolic or imaginative play.

C. Not better accounted for by RettÕs Disorder ofChildhood Disintegrative Disorder.

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A little history…

First reports: Leo Kanner (1943), Hans Asperger (1944)-Impairments in social interactions-Resistance to changes-Oversensitivity to some stimuli (sound)

Aspects of the original report that have been refuted-Parent were successful educationally or professionally-Problems relationships between parent and children

(Refrigerator mothers!)-Not related to other medical conditions-No mental retardation

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1950s- Autism is an early form of schizophrenia

-In 1971 Kolvin demonstrated a bimodal onset among a largegroup of ÒpsychoticÓ children- early onset in 1-2 years, lateronset after many years of normal behavior

-Early onset showed impairments in social, cognitive andlanguage (autism-like), no increased schizophrenia in families

-Later onset showed delusions, hallucinations and other featuresof schizophrenia

-Autism differed from schizophrenia in time of onset, clinicalfeatures, course, outcome and family history

A little history…

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Epidemiology of autism

-First epidemiological studies in England in the 1960s

-Since then more than 30 studies in many countries

-All have used a definition of autism that included severeimpairment in communication, language, socialinteractions, play and behavior

-BUT- the criteria for autism diagnosis has changed over time

-Studies range from 1966 to 2001

-In general smaller studies give higher prevalence

-Total number of children surveyed is around 5 million

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Epidemiology of autism

Rates of autism-Prevalence estimates range from 0.7/10,000 to 72.6/10,000-Prevalence rates higher with smaller sample size-average prevalence 10/10,000

Mental retardation-Assessment of intellectual function in 20/32 studies-30% showed no intellectual impairment (6.6-100%)

Gender-male/female sex ratio averaged 4.3 over all studies-Range 1.33 to 16-No study ever identified more girls than boys-Gender difference greater in non-mentally retarded subjects

5.75 to 1 in normal intellectual function group2:1 in groups with mental retardation

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Neuropathology

Increased head size

-Kanner described large heads in some children with autism

-Macrocephaly found in 20% of autistic individuals

-Not present in the first year of life

-Consistent with finding of increased brain weight

-Recent studies suggest that increases are transient (2-4 yrs)

-Neuroimaging has shown increased brain volume

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Schumann, C. M. et al. J. Neurosci. 2004;24:6392-6401

Figure 1. Orthogonal views for segmenting the amygdala and hippocampus on MRI

sections

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Controversies in autism

Causes of autism-Incidence-The role of the parent-Vaccines-Environmental toxins-Food allergies

Treatments for autism-Secretin-Diets-Facilitated communication-Drugs-Behavioral

Behavioral/Social issues-What distinguishes autism from other PDDs-Male/female differences-Mental retardation

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Bumps

into

people

in li

ne…

Difficulty with hair washing and brushing…

Overly sensitive to

loud noises…

Problems with handwriting…

Picky eater…Always “on the

go”…

Only likes certain types of clothing…

CHARACTERISTICS OF CHILDREN WITH AUTISM SPECTRUM CONDITIONS

Difficulty paying attention…

Clumsy…

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S U C C E S S W I T H A U T I S M

Definition

If you are productive and fulfilled with your life you are probably successful