What is autism ?

OverviewWhat is Autism?Is there more than one type of Autism?What causes Autism?How is Autism diagnosed?What are the characteristics of Autism?What are the most effective approaches to

treating Autism? Is there a cure?

WHAT IS AUTISM?Very complex, often baffling

developmental disabilityFirst described by Leo

Kanner in 1943 as early infantile autism

“Auto” – children are “locked within themselves.”

For next 30 years, considered to be an emotional disturbance

WHAT IS AUTISM?3 categories for autism in IDEA?Today, autism is a severe form of a broader

group of disordersThese are referred to as pervasive

developmental disorders (later)Typically appears during the first 3 years of

life

WHAT IS AUTISM?Very likely neurological in origin – not

emotional, not the refrigerator momPrevalence figures vary widely (textbook

says 5/10,000, but recent data say as high as 1/1000 or even 1/500.

4 times more prevalent in boysNo known racial, ethnic, or social

boundariesNo relation to family income, lifestyle

WHAT IS AUTISM?Autism impacts normal development of the

brain in areas of social interaction and communication skills.

Difficult to communicate with others and relate to the outside world.

Occasionally, aggressive and/or self-injurious behavior may be present.

WHAT ARE THE TYPES?Actually, the “umbrella” heading is

Pervasive Developmental Disorder (PDD).Autism is one of the 5 PDDs.All have commonalities in communication and

social deficitsDiffer in terms of severity

1. Autistic DisorderImpairments in social interaction,

communication, and imaginative play.Apparent before age 3.Also includes stereotyped behaviors,

interests, and activities

2. Asperger’s DisorderImpairments in social interactions, and

presence of restricted interests and activitiesNo clinically significant general delay in

languageAverage to above average intelligence

3. Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)Often referred to as atypical autismUsed when a child does not meet the criteria

for a specific diagnosis, but there is severe and pervasive impairment in specified behaviors

4. Rett’s DisorderProgressive disorder which, to date, has only

occurred in girls.Period of normal development and then the

loss of previously acquired skillsAlso loss of purposeful use of hands, which is

replaced by repetitive hand movementsBeginning at age of 1-4 years

5. Childhood Disintegrative DisorderNormal development for at least the first 2

yearsThen significant loss of previously acquired

skills

Conclusions on TypesAutism is a spectrum disorderThis means that symptoms and

characteristics can present themselves in wide variety of combinations, from mild to severe

Autistic individuals can be very different from each other

“Autism” is still commonly used to refer to any of the 5 PDDs

What causes (and doesn’t cause) autism?Good agreement in general that autism is

caused by abnormalities in brain development, neurochemistry, and genetic factors

Bettleheim’s theory of psychogenesis?

How is Autism Diagnosed?No definitive medical testTeam uses interviews, observation, and

specific checklists developed for this purpose.

Team might include neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, etc.

Must rule out MR, hearing impairment, behavior disorders, or eccentric habits

CHARACTERISTICS1. Communication/Language2. Social Interaction3. Behaviors4. Sensory and movement disorders5. Resistance to change (predictability)6. Intellectual functioning

1. Communication/languageBroad range of abilities, from no verbal

communication to quite complex skillsTwo common impairments:A. Delayed languageB. Echolalia

A. Delayed language50% of autistic individuals will eventually

have useful speech (?)Pronoun reversal: “You want white

icing on chocolate cake.”Difficulty in conversing easily with othersDifficulty in shifting topicsLook away; poor eye contactFacilitated communication??????

Elements of Facilitated Communication1. Physical Support2. Initial training/introduction3. Maintaining focus4. Avoiding competence testing5. Generalization6. Fading

B. EcholaliaCommon in very young children (Age 3)Immediate or delayed (even years)Is there communicative intent with echolalia?

2. Social InteractionOne of hallmarks of autism is lack of social

interaction1. Impaired use of nonverbal behavior2. Lack of peer relationships3. Failure to spontaneously share enjoyment,

interests, etc. with others4. Lack of reciprocityTheory of mind?

3. BehaviorsRepetitive behaviors, including obsessions,

tics, and perseverationImpeding behaviors (impede their learning

or the learning of others)Will need positive behavior supportsA. Self-injurious behaviorB. Aggression

4. Sensory and movement disordersVery commonOver- or under-sensitive to sensory stimuliAbnormal posture and movements of the

face, head, trunk, and limbsAbnormal eye movementsRepeated gestures and mannerismsMovement disorders can be detected very

early – perhaps at birth

5. PredictabilityChange in routine is very stressfulMay insist on particular furniture

arrangement, food at meals, TV showsSymmetry is often importantInterventions need to focus on preparing

students for change if possible

6. Intellectual functioningAutism occurs in children of all levels of

intelligence, from those who are gifted to those who have mental retardation

In general, majority of individuals with autism are also identified as having mental retardation – 75% below 70

Verbal and reasoning skills are difficultSavant syndrome

Interventions1. Individualization and early intervention

are the keys2. Include life skills, functional academics,

and vocational preparation3. Positive behavior support4. Social stories (music therapy?)5. Lovaas model

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