Autism and Social (Pragmatic) Communication Disorder · PDF fileAutism and Social (Pragmatic)...

Autism and Social (Pragmatic)

Communication Disorder:

A DSM-5® Update

Anita Remig, Ed.D., F.P.P.R. www.remigbiofeed.com

Autism and Social (Pragmatic) Communication Disorder: A DSM-5® Update

Anita Remig, Ed.D., F.P.P.R.

Cross Country Education

Leading the Way in Continuing Education and Professional Development www.CrossCountryEducation.com

To comply with professional boards/associations standards: • I declare that I or my family do not have any financial relationship in any amount, occurring in the last 12 months with a

commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved have no financial relationship.

• I declare that I do not have any relevant non-financial relationships. • Requirements for successful completion is completing this educational offering, passing the test at 75% or higher, and

completing the evaluation form. • Cross Country Education and all current accreditation statuses do not imply endorsement of any commercial products

displayed in conjunction with this activity.

Copyright © 2015 Anita Remig Cross Country Education

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DSM, DSM-IV-TR, and DSM-5 are registered trademarks of the American Psychiatric Association. The American Psychiatric Association is not affiliated

with nor endorses this seminar.

Objectives

• Describe factors contributing to the dramatic increase in Autism and Social (Pragmatic) Communication Disorder

• Contrast the differences between Autism and Social (Pragmatic) Communication Disorder

• Explain methods for differential diagnosis

• Assess examples for how to improve children’s social and language development

• Evaluate behavioral and communicative strategies


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Grandjean P, Landrigan PJ (2014)

Neurobehavioral effects of developmental toxicity, Lancet Neurology, 13, 330-338.

• Neurodevelopmental disabilities: autism, ADHD, dyslexia, and other cognitive deficits

• Debilitate millions of children

• Developmental Disorders are increasing in frequency

• Industrial chemicals injure the developing brain causing rise in prevalence


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Grandjean P, Landrigan PJ (2014) [Cont’d] • In a 2006 systematic review

identified five industrial chemicals as developmental neurotoxicants:

1. lead

2. methylmercury

3. polychlorinated biphenyls (PCB)

4. arsenic

5. toluene


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Childhood Neurodevelopmental Disorders Highest Ever Recorded • Houtrow, Amy (August 2014) Pediatrics.

• The percentage of children with disabilities due to neurodevelopmental or mental health conditions continues to rise, particularly among children in more socially advantaged households

• Recent study found there has been a decline in physical health problems by 12 percent

• Study found a 21 % rise in neuro-developmental disorders


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Childhood Neurodevelopmental Disorders Highest Ever Recorded (Cont’d)

• National Health Interview Survey conducted by the U.S. CDC (2001 to 2011) evaluated children’s ability to perform activities at home and school

• Children living in poverty have the highest rates of disability

• Children living in families at the federal poverty level reported a 28.4 percent increase in disabilities over the past 10-year period


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• “The pediatric health care system needs to adapt to assure the best possible health and functional outcomes for children with disabilities…”

• “Documenting the changes in childhood disabilities is an important step in developing better prevention and treatment…” Copyright © 2015 Anita Remig Cross Country Education

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• The research was funded by grants from the National Institutes of Health and Department of Health and Human Services

• Changing Trends of Childhood Disability, 2001-2011, Amy J. Houtrow, MD, PhD, MPH, Kandyce Larson, PhD, Lynn M. Olson, PhD, Paul W. Newacheck, DrPH, and Neal Halfon, MD, MPH, Pediatrics, August 2014.


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Center for Disease Control and Prevention, 3-27-2014 • CDC estimates 1 in 68 children has been identified with

autism spectrum disorder

• Latest snapshot shows proportion of children with autism on the rise

• 30 percent higher than previous estimates reported in 2012 of 1 in 88 children

• Range: 1 in 175 in Alabama to 1 in 45 in New Jersey

• “Prevalence of Autism Spectrum Disorder among Children Aged 8 Years, 11 Sites,” Morbidity and Mortality Weekly Report


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Autism: Oxidative Stress, Inflammation and Immune Abnormalities • Chauhan, Abha et al (2010) Autism: Oxidative Stress,

Inflammation and Immune Abnormalities. NY, CRC Press

• “…oxidative stress occurs in the autistic brain and results in neurodegeneration that in turn contributes to symptoms”

• “…axons of cholinergic neurons in white matter are primary site of oxidative damage”

• “…genetic predispositions to oxidative stress triggers…which alters neurotrophins”


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Autism: Oxidative Stress, Inflammation and Immune Abnormalities (Cont’d) • Environmental exposures to toxins and metals seep into

cells of body and brain

• Cells are altered: produce variant gene products

• Cell changes lead to prolonged oxidative stress

• Oxidative stress gives rise to inflammatory responses

• Methylation occurs---which adds new molecules onto strands of DNA altering gene structure and function

• Methylation causes inhibited methionine and capacity to get rid of toxins


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Childhood Developmental Disorders Causes include environmental toxins

added to susceptibility genes which give rise to:

Faulty environmental inheritance

Oxidative stress

Inflammation

Endocrine changes

Immune system errors (autoimmunity)

Neural tube migration disorders


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Research Tool Can Detect Autism at 9 Months of Age • The ability to detect autism in children

as young as 9 months of age is on the horizon

• The Early Autism Study, led by Dr. Melissa Rutherford, (McMaster University), has been using eye tracker technology that measures eye direction while the babies look at faces, eyes, and bouncing balls on a computer screen

• Rutherford presented her peer-reviewed research at the 7th Annual International Meeting for Autism Research in London


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Research Tool Can Detect Autism at 9 Months of Age (Cont’d)

• Autism is distinguishable at 9 months

• “I can do this in 10 minutes, and it is objective, meaning that the only measure is eye direction; it’s not influenced by a clinician’s report or by intuition. Nobody’s been able to distinguish between these groups at so early an age.“ Dr. Melissa Rutherford


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Leo Kanner 1940 • “One of the children spun with great pleasure

everything he could seize upon to spin. Many of the children flapped their hands, flew into unpredictable bouts of rage and aggression, spoke in inexplicable ways if they spoke at all, sometimes referring to themselves as “you” or others as “I”, showed remarkable abilities like keen memory or perfect pitch but abject inability to perform simple tasks, obsessed over objects but ignored human beings.”


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AUTISM SPECTRUM DISORDERS

DSM-5® Diagnostic Criteria

ASD: Criterion A

Diagnostic Criteria

A.Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history: 1. Deficits in social-emotional reciprocity:

abnormal approach and failure of back and forth conversation

reduced sharing of interests, emotions

failure to initiate or respond to social interactions


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ASD: Criterion A (Cont’d)

2. Deficits in nonverbal communicative behaviors used for social interaction Poorly integrated verbal and nonverbal communication

Abnormal eye contact; body language

Deficits in understanding and use of gestures

Total lack of facial expression and nonverbal communication


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ASD: Criterion A (Cont’d)

3. Deficits in developing, maintaining, understanding relationships Difficulties adjusting behavior to suit various social context

Difficulties sharing imaginative play or making friends

Absence of interest in peers


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ASD: Criterion B

B. Restricted, repetitive patterns of behavior, interests or activities, as manifested by at least two of the following, currently or by history Stereotyped or repetitive motor movements, use of objects,

or speech

Insistence on sameness, inflexible adherence to routines, ritualized patterns of verbal or nonverbal behavior

Highly restricted, fixated interests that are abnormal in intensity or focus

Hyper- or Hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment


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ASD: Criteria C, D, E

C.Symptoms must be present in early developmental period

D.Symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning

E.Symptoms are not better explained by intellectual disability, global developmental delay ASD and intellectual disability can co-occur


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ASD Specifications

• With or without intellectual impairment

• With or without language impairment

• Associated with a known medical/genetic condition or environmental factor

• Associated with another neuro-developmental, mental or behavioral disorder

• With catatonia


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ASD: Severity Levels

• Level 3: requires very substantial support

• Level 2: requires substantial support

• Level 1: requires support


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DSM-5®: Diagnostic Features

• The stage where the child’s functional impairment becomes obvious varies according to the individual and environment

• Supports may mask symptoms and delay diagnosis

• Manifestations of ASD vary greatly, hence “spectrum”

• Diagnosis most valid when using multiple sources of information: clinician observation, caregiver history, self-report

• Not a degenerative disorder; improves with training


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DSM-5®: Risk Factors

• Environmental risk factors: older parents, low birth weight, exposure to valproate in utero

• Genetic risk factors: some gene copy number variants are involved, but there is no gene or set of genes (ASD is polygenic---multitude of loci)

• Gender: 4 males to 1 female Copyright © 2015 Anita Remig Cross Country Education

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DSM-5® Differential Diagnosis

• Rett syndrome

• Selective mutism

• Language disorder or Social pragmatic communication disorder

• Intellectual disability

• Stereotypic movement disorder

• Attention-Deficit Hyperactivity Disorder

• Schizophrenia


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DSM-5®: Comorbidities

• 70% with ASD have one comorbid mental disorder

• 40% have two


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Overlapping Symptoms

ASD and ADHD

White Matter Microstructure Predicts Autistic Traits in Attention-Deficit/Hyperactivity Disorder

• Cooper M et al, J Autism Dev Disord. 2014 May 15.

• Traits of ASD in Ss with ADHD have previously been found to index clinical severity

• Clear link: ASD traits in adolescent males with ADHD

• Compared white matter microstructure relative to controls

• Significant associations were found in ASD severity in the following brain structures: Right posterior corticospinal tract

Right cerebellar peduncle

Midbrain


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White Matter Microstructure Predicts Autistic Traits in Attention-Deficit/Hyperactivity Disorder (Cont’d)

• Significant findings of a WM microstructural brain alteration of autistic traits in ADHD

• In the absence of full disorder, ASD traits may index an overlapping neurobiology with ADHD children and adults


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ASD and Motor Disorders

Autism, Motor Abnormalities and DSM-5®

• “Motor deficits are often present including odd gait, clumsiness and other abnormal motor signs.”

• “Self-injury may occur…”

• “Some individuals develop catatonic-like motor behavior (slowing and freezing mid-action)”

--P 55


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Abnormal Repetitive Behaviors: Shared Phenomenology and Pathophysiology • J Intellect Disabil Res. 2012, 56(5):427-40. Muehlmann AM et al

• Self-injurious behavior (SIB) is a devastating neurodevelopmental disorder

• SIB part of genetic syndromes and developmental disabilities

• SIB and repetitive behaviors, such as stereotypy, compulsions and tics, share many phenotypic similarities

• Overlapping pathophysiology for stereotypy, compulsions and tics

• Typical in autism, obsessive compulsive disorder, Tourette syndrome

• Cortical basal ganglia circuitry dysfunction mediates repetitive behavior


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Motor Stereotypies in Children with Autism and Other Developmental Disorders • Dev Med Child Neurol. 2009 Jan;51(1):30-8. Goldman S et al

(2009)

• Characterize the range of stereotypies--repetitive rhythmical, apparently purposeless movements

• Compare developmentally impaired children with and without autism

• Determine whether some types are more prevalent and diagnostically useful in children with autism

• Authors described each motor stereotypy recorded during 15 minutes of archived videos of play in 277 children (209 males, 68 females)


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Motor Stereotypies in Children with Autism and Other Developmental Disorders (Cont’d)

• More children with autism had stereotypies than comparison children

• Autism contributed independently to the occurrence, number, and variety of stereotypies

• Non-autistic children without cognitive impairment had the least number of stereotypies

• Children with autism and low NVIQ had the most


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Motor Coordination in Autism Spectrum Disorders: A Synthesis and Meta-Analysis

• Fournier, Kimberly A et al (2010) Journal of Autism & Developmental Disorders, 40 Issue 10, p1227-1240

• Motor coordination deficits a cardinal feature of Autism Spectrum Disorders

• Database searches identified 83 ASD studies on motor coordination, arm movements, gait, or postural stability deficits

• Rigorous meta-analysis technique used showing large effect

• Substantial motor coordination deficits in the ASD groups across a wide range of behaviors

• The current overall findings portray motor coordination deficits as pervasive and a main feature of ASD


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ASD and Sensory Issues

Autism, Sensory Issues and DSM-5®

• “Some fascinations and routines may relate to apparent hyper or hyporeactivity to sensory input, manifested through extreme responses to specific sounds or textures , excessive smelling or touching of objects and sometimes apparent indifference to pain, heat or cold.”

--P 54 Copyright © 2015 Anita Remig Cross Country Education

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Autism and Sensory Processing Disorders: Shared White Matter Disruption

• PLoS One. 2014, 30;9(7). Chang YS et al

• Over 90% of children with Autism Spectrum Disorders (ASD) demonstrate atypical sensory behaviors

• Hyper- or Hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment is now included in the DSM-5® diagnostic criteria

• There are children with sensory processing differences who do not meet an ASD diagnosis but do show atypical sensory behaviors to the same or greater degree as ASD children


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Autism and Sensory Processing Disorders: Shared White Matter Disruption (Cont’d)

• Sensory Processing Disorders (SPD) involve impaired white matter microstructure

• White matter microstructural pathology correlates with atypical sensory behavior

• ASD (n = 15), SPD (n = 16), typical children (n = 23)

• Both the SPD and ASD cohorts demonstrate decreased connectivity relative to controls in parieto-occipital tracts involved in sensory perception and multisensory integration

• ASD group alone shows impairment in temporal tracts to social-emotional processing


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Autism

OCD

ADHD

Language

Impulsivity Anxiety

Aggressive

EEG

Eric Hollander, M.D. (2011)

• The Scientist 2011

• Dr. Hollander, in collaboration with a patient’s parent (Immunologist), used whipworm to treat autistic child

• The parent, Steward Johnson, showed Trichuris suis, a parasite found in the intestines of pigs, successfully treated autoimmune disorders

• Autism symptoms were the result of the immune system attacking specific brain cells

• Putting the two together, Mr. Johnson and Dr. Hollander tried the treatment — which has proven successful in curbing the patient's worst behaviors


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Eric Hollander, M.D.

Neuropsychopharma.

(2003) 28, 1186–1197.

Divalproex in the Treatment of Impulsive Aggression: Efficacy in Cluster B Personality Disorder

He has extended this work to treat autistic children and teens in this way with notable success.


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Eric Hollander, M.D. (Cont’d)

• Neuropsychopharmacology (2003) 28, 193–198.

• Oxytocin infusion reduces repetitive behaviors in adults with autism

• Abnormalities exist in peptide systems, particularly the oxytocin

• Oxytocin plays a role in social and repetitive behaviors

• Outcome measure was an instrument rating six repetitive behaviors: need to know, repeating, ordering, need to tell/ask, self-injury, and touching

• Significant reduction in repetitive behaviors following oxytocin infusion in comparison to placebo


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Treatment

• Early treatment is crucial—Do not “wait and see”

• Consider causation, bidirectional causation, diagnosis, family history, culture, susceptibility genes, toxic exposure

• Emphasize early, intensive treatment


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BREAK

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Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder

Frank Porter Graham Child Development Institute

University of North Carolina at Chapel Hill 2014

The following strategies have strong evidence supporting their use in training people with ASD

Antecedent-Based Intervention

• Organizing and altering of events or circumstances that precede the beginning of an unwanted and interfering behavior

• Designed to lead to the reduction of the unwanted behavior


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Discrete Trial Training

• Behavioral instruction with one teacher or clinician with one student/client which is designed to teach through positive reinforcement a designated skill or sequence of skills

• Instruction includes one to several trials

• Each trial is directly related to the last and consists of the teacher’s request, child response, and planned consequence


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Exercise

• Planned physical exertion and aerobic performance aimed at eliciting energy expenditure

• Physical exertion designed to reduce problem behavior and bring forward expected behavior


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Extinction

• Withdrawal of positive reinforcers that are maintaining unwanted behavior

• Often used with functional communication training


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Functional Communication Training • Circumventing and altering

unwanted behavior that has a communicative function

• Helping the child to seek a more appropriate way to ask for what he or she needs


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Naturalistic Intervention

• Strategies and tactics that take place in the setting where the child lives or learns

• Alter the setting to entice and engage attention and learning

• Provide support for the child to learn targeted behavior

• Elaborate on the behavior when it occurs

• Encourage and allow for natural consequences


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Parent-Implemented Intervention

• Mothers, fathers, relatives provide specialized interventions to children to improve behavior

• Increase positive and decrease negative behavior which impedes learning and socialization

• A structured parent training program is administered to parent


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Peer-Mediated Instruction and Intervention • Peers with skills teach and support

children and teens with ASD to learn new skills, communicate, socialize

• Natural environments used in schools and community centers to nurture and educate people with ASD

• Overseen by teachers, counselors or parents at all times


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Prompting

• Strong research support to show verbal, gestural, physical support is given to learners to help them acquire a specific behavior or sets of behavior

• Prompts provided by an adult or peer before and during skill acquisition


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Response Interruption and Redirection • Provide a cue, suggestion, or distraction

when an unwanted behavior takes place

• Designed to divert the person’s attention away from the negative behavior

• Goal is to reduce undesirable behavior while showing the positive, desirable behavior


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Self-Management

• Teaching focused on people learning to discriminate between desirable and undesirable behavior

• Record one’s own behavior

• Reward self for recording, then reducing unwanted behavior


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Social Narratives

• Stories and descriptions written with detail to describe relevant behavioral routines or sequences

• Examples of positive responses are given

• Each narrative is individualized according to child’s needs

• Story is short and can included pictures


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Technology-Aided Instruction

• Technology supports learning

• Electronic equipment/hardware/software or virtual network

• Intended to increase, maintain, improve skills in daily living, learning, recreation


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Video Modeling

• A visual, video model of the targeted behavior

• In the realm of skills, communications, play, or social behavior

• Video recording allows child to watch it repeatedly


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Visual Support

• Any visual display that facilitates student engagement and enhances mastery of material

• Picture exchange communication included

• Any pictures, large print words, objects, arranging visual boundaries, schedules, maps, labels, organization systems, timelines, wall-mounted notes, and the like


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There is some weaker research support for the following interventions for ASD:

Weaker Evidence Base

• Cognitive–Behavioral Interventions

• Functional Behavior Assessment

• Pivotal Response Training

• Scripting

• Social Skills Training

• Task Analysis


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Early Start Denver Model for Young Children with Autism • S. J. Rogers and G. Dawson. (2009) The Early Start

Denver Model for young children with Autism: promoting language, learning and engagement. The Guildford Press, New York, ISBN: 978-1606236314.

• Model teaches developmental skill intensively

• Focus is on social/communicative skill

• This prevents cascade of neurological deficits

• Intensive ABA teaching along with relationship-based training for home, peers, groups, one on one work


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Early Start Denver Model for Young Children with Autism

• 12- to 18-month olds, randomized controlled experimental design

• 48 children in 2 year study—Denver

• 20 hours of intensive therapy per week, 5 hours of parent training per week

• Experimental group: average 18 point IQ increase

• 7 Ss upgraded diagnosis from autism to PDD-NOS


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Infant Start Therapy: Treatment based on Early Start Denver Model • Sally J. Rogers and Sally Ozonoff, Autism treatment in the

first year of life: A pilot study of Infant Start, a parent-implemented intervention for symptomatic infants. Journal of Autism and Developmental Disorders, Sept, 2014

• Intervention in 6-month-olds with autism eliminates symptoms, developmental delay

• 'Infant Start' therapy removes disabling delay before most children are diagnosed

• Treat at the earliest age when ASD appears---as young as 6 months old - significantly reduces symptoms so that, by age 3, most have no symptoms


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Infant Start Therapy

• Early identification crucial: Infant Start, was administered over a six-month period to 6- to 15-month-old infants who exhibited marked autism symptoms

• Delivered by the people who were most in tune with and spent the most time with the babies: their parents.

• Six out of seven children, caught up in all of their learning skills and their language by the time they were 2 to 3

• Taking away deficits and speeding up developmental rates---due to parents’ efforts


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Infant Start Therapy

• The intervention focused on increasing:

Infant attention to parent faces and voices

Parent-child interactions that attract infants' attention, bringing smiles and delight to both

Parent imitation of infant sounds and intentional actions

Parent use of toys to support social attention

• The treatment sessions included:

Greeting and parent progress sharing

A warm-up period of parent play, followed by discussion

Discussion of a new topic, using a parent manual

Parents interacting in a daily routine with coaching from therapists


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Social (Pragmatic) Communication Disorder

DSM-5® Diagnostic Criteria: Social (Pragmatic) Communication Disorder

Criterion A. Persistent difficulties in the social use of verbal and nonverbal communication:

1. Deficits in using communication for social purposes

2. Impairment in the ability to change communication to match context or the needs of the listener, such as speaking differently in the classroom as opposed to the playground

3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation

4. Difficulty understanding what is not explicitly stated (making inferences) and nonliteral or ambiguous meanings of language (idioms, humor)


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DSM-5® Diagnostic Criteria: Social (Pragmatic) Communication Disorder (Cont’d) Criterion B: These deficits result in functional limitations in effective communication, social participation, social relationships, academic or occupational achievement (individually or in combination)

Criterion C: The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).


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DSM-5® Diagnostic Criteria: Social (Pragmatic) Communication Disorder (Cont’d)

Criterion D: The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar and are not better explained by ASD, intellectual disability, global developmental delay or another mental disorder.


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DSM-5® Diagnostic Criteria: Social (Pragmatic) Communication Disorder (Cont’d)

• Diagnostic Features: Primary difficulties with pragmatics or

the social use of language and communication:

Understanding and following rules of social communication in natural contexts

Changing language according to the needs of the listener or situation

Following rules for conversation and storytelling

Associated feature is language impairment, ADHD, learning disorders, behavior problems


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Research Review on SPCD: Norbury (2014) • Courtenay F. Norbury, (2014) Social (pragmatic)

communication disorder conceptualization, evidence and clinical implications. Journal of Child Psychology and Psychiatry 55:3, 204–216

• Thesis: Language impairment is primary and social deficits are secondary

• Social communication and pragmatic language are two separate issues with some overlap

• Pragmatics: understanding words in context, drawing inferences, and resolving ambiguity


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Research Review on SPCD: Norbury (2014) [Cont’d] • Social communication: ability to relate to

people using language

• Strong correlations presented between language test performance and measure of social deficits

• SPCD is conceptualized as a dimensional symptom profile

• SPCD presents across a range of neuro-developmental disorders: ADHD, Conduct Disorder, closed head injury, Williams Syndrome, Spina Bifida


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Research Review on SPCD: Norbury (2014) [Cont’d] • Lack of reliable and culturally valid assessment measures

to make a differential diagnosis between SPCD, ASD and Pragmatic Language Impairment (ICD-10)

• In the DSM-5®, one cannot have rote, repetitive behavior (RRB), yet research shows those subjects diagnosed with SPCD have both verbal and non-verbal RRB

• Sensory issues are not part of DSM-5® diagnosis, yet research confirms that SPCD subjects have sensory problems

• The author shows evidence to suggest that differential diagnosis of ASD and SPCD is not reliable


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Pragmatic Language Strategies

Pragmatic Strategies

• Rote verbal monologues are common: use 3 sentence rule to avoid rote monologues

• Teach communicative intent: “when you talk it ought to mean you intend to share ideas”

• Conversational goal is the sharing of cogent and logical content among speakers: emphasize that talk is intended to share ideas Copyright © 2015 Anita Remig Cross Country Education

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Pragmatic Strategies (Cont’d)

• Intentions are expressed in blunt, direct manner: teach contrast of rude vs. polite

• Eye-to-eye gaze is avoided: teach a system of 10 seconds on eye-to-eye, then 3 seconds for a break

• During conversation: teach child to continue eye gaze pattern (10 on, 3 off)

• Lack of question-asking: directly teach how to ask questions


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• Instrumental and personal need expressed more than descriptive statements: teach child to describe

• Child tends not to ask for clarification: teach the question, “Can you tell me more?”

• “Shared attention” lags behind: teach follow-up talk using one idea from co-speaker’s utterance

• Speech is often aprosodic: use tape recorder of child and adult model


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Early topic maintenance strategy in neuro-typical children is repetition: teach child to repeat word or phrase from co-speaker

Later, children use elaboration: help child to add more words to the repetition

Age 5 children smooth transitions into new topics: teach words such as “So, then, I mean to say”


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Bibliography


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• Amy J. Houtrow et al. Changing Trends of Childhood Disability, 2001-2011. Pediatrics August 2014

• Anholt, Gideon et al (2010) Autism and ADHD Symptoms in Patients with OCD: Are They Associated with Specific OC Symptom Dimensions or OC Symptom Severity? Journal of Autism & Developmental Disorders, Vol. 40, p580-589.

• Ashley de Marchena et al. (2011). Mutual exclusivity in autism spectrum disorders: Testing the pragmatic hypothesis. Cognition, 119, 96-113.

• Barnard-Brak, Lucy (2011) The difference between autism and ADHD is in the eye of the cognitive task? Personality & Individual Differences, 50 p1305-1308.

• Catherine Adams et al. (2012). The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school-age children who have pragmatic and social communication problems with or without autism spectrum disorder. Int J Lang Commun Disorders, 47, 233-244.

• Chang, YS et al. Autism and sensory processing disorders: shared white matter disruption. PLoS One. 2014, 30; 9(7).

• Chauhan, Abha et al (2010) Autism: Oxidative Stress, Inflammation and Immune Abnormalities. NY, CRC Press

• Cheal, J. L., Heisz, J., Walsh, J. A., Sheeden, J., & Rutherford, M. (2014). Afterimage induced neural activity during emotional face perception. Brain Research, 1549, 11-21.

• Cooper, M. et al. White Matter Microstruture Predicts Autistic Traits in Attention-Deficit/Hyperactivity Disorder. J Autism Dev Disord. 2014 May 15.

• Courtenay F. Norbury, (2014) Social (pragmatic) communication disorder conceptualization, evidence and clinical implications. Journal of Child Psychology and Psychiatry 55:3, 204–216

Bibliography (Cont’d) • Diagnostic and Statistical Manual of Mental Disorders, 5th edition, American Psychiatric Association Press,

Washington, DC, 2014.

• Fournier, Kimberly A et al (2010). Motor coordination in autism spectrum disorders: a synthesis and meta-analysis. Journal of Autism & Developmental Disorders 40 (10): 1227-1240.

• Goldman S. et al (2009). Motor stereotypies in children with autism and other developmental disorders Dev Med Child Neurol. 2009 Jan; 51(1): 30-8.

• Grandjean P, Landrigan PJ (2014) Neurobehavioral effects of developmental toxicity, Lancet Neurology, 13, 330-338.

• Grzadzinski R, Castellanos FX. (2010) Examining autistic traits in children with ADHD: does the autism spectrum extend to ADHD? J Autism Dev Disord.

• Hollander, Eric, Alex Kolevzon, and Joseph T. Coyle (2011) Textbook of Autism Spectrum Disorders. Washington DC, American Psychiatric Press.

• Hollander, Eric (2003) Autism Spectrum Disorders. NY,NY Marcel Dekker, Inc

• Janet Baxendale et al. (2013). Parent and teacher perceptions of participation and outcomes in an intensive communication intervention for children with pragmatic language impairment. International Journal Lang Commun Disorders, 48, 41-53.

• Joshi G et al (2014) Symptom Profile of ADHD in Youth With High-Functioning Autism Spectrum Disorder: A Comparative Study in Psychiatrically Referred Populations. J Attention Disorders.

• Kanner L (1943). Autistic disturbances of affective contact. Nerv Child 2: 217–50.

• Kanner L (1949). Problems of nosology and psychodynamics in early childhood autism. Am J Orthopsychiatry 19 (3): 416–26.


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Bibliography (Cont’d) • Kanner L, Eisenberg L (1956). Early infantile autism 1943–1955. Am J Orthopsychiatry 26 (3): 556–66.

• Lord, Catherine, & Bishop, Somer L. (2015). Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum disorder. Annu. Rev. Clin. Psychol., 11, 53-70.

• Mayes, Susan (2011) Use of Gilliam Asperger’s Disorder Scale In Differentiating High, Low Autism & ADHD. Psychological Reports, Feb2011, Vol. 108 Issue 1, p3-13.

• McEntire, Nancy (2010) A Comparison of Motor Delays in Young Children: Autism Spectrum Disorder, Developmental Delay, and Developmental Concerns. Childhood Education, 86 Issue 3, p202-202

• Mostofsky, Stewart (2009) Decreased connectivity and cerebellar activity in autism during motor task performance. Brain: A Journal of Neurology; 132 Issue 9, p2413-2425.

• Muehlmann Am et al Abnormal repetitive behaviors: shared phenomenology and pathophysiology. J Intellect Disabil Res. 2012, 56(5): 427-40.

• Porter Graham Child Development Institute, Autism Evidence-Based Practice Review Group.

• Robert L Koegel et al. (2014). Improving Question-Asking Initiations in Young Children with Autism Using Pivotal Response Treatment. Journal of Autism and Dev Disorders, 44, 816-827.

• Rutherford, M. (2013). Social Attention is measurably and increasingly atypical across the first six months in the broader autism phenotype. Journal of Psychology & Psychotherapy, 3(4), 1-7.

• Rutherford, M.D., Young, G.S., Hepburn, S., & Rogers, S. (2009) A Longitudinal Study of Pretend Play in Autism. Journal of Autism and Developmental Disorders, 37, p1024-1039,

• Rutherford, M (2008) Eye Direction, Not Movement Direction Predicts Attention Shifts in Those with Autism. Autism Spectrum Disorders, 38, 1958-1965.


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Bibliography (Cont’d) • Rutherford, M.D., & McIntosh, D. (2006). Rules versus Prototype Matching: Strategies of Perception of Emotional

Facial Expressions in the Autism Spectrum. Journal of Autism and Dev Disorders, 37, p187-196

• Sally J. Rogers and Sally Ozonoff, Autism treatment in the first year of life: A pilot study of Infant Start, a parent-implemented intervention for symptomatic infants. Journal of Autism and Developmental Disorders, Sept, 2014

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• Volden, Joanne, & Phillips, Linda. (2010). Measuring Pragmatic Language in Speakers with Autism Spectrum Disorders: Comparing the Children's Communication Checklist-2 and the Test of Pragmatic Language. American Journal of Speech-Language Pathology, 19, 204-212.

• Wong, C., Odom, S. L., Hume, K. Cox, A. W., Fettig, A., Kucharczyk, S., Schultz, T. (2013). Evidence-based practices for children, youth, and young adults with Autism Spectrum Disorder. Chapel Hill: The University of North Carolina


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Anita Remig, Ed.D., F.P.P.R.

[email protected] www.remigbiofeed.com


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Autism and Social (Pragmatic)

Communication Disorder:

A DSM-5® Update

Anita Remig, Ed.D., F.P.P.R. www.remigbiofeed.com

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