Autism M01

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AUTISM AND OTHER PERVASIVEDEVELOPMENTAL DISORDERS

Online Continuing Education Course

Presented by Care and ComplianceGroup, Inc.

Care and Compliance Group, Inc. and the authors of this course have

attempted to offer useful information and assessment tools that have been

accepted and used by professionals. Nevertheless, changes in the health

care delivery regulations and medical technology will alter the application

of some concepts and techniques presented in this course.

Care and Compliance Group, Inc. and the authors of this course disclaim

any liability, loss, injury, or damage incurred as a consequence, directly or

indirectly, of the use and application of any of the concepts in this course.

All rights reserved. No part of this course may be reproduced or utilized inany form, by any means, electronic or mechanical, including photocopying,

recording, or any information storage and retrieval system, without

permission in writing from Care and Compliance Group, Inc.

Enrolled learners have permission to print the materials in this course for

their own use only as a study aid during their completion of this course.

IMPORTANT NOTICE

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This course presents current information on the Autism

Spectrum Disorders (ASD). Common terminology,

characteristics, screening recommendations, diagnostic

criteria, and management of ASD is presented. Participants

will learn the diagnostic criteria and distinguishing

characteristics of Autism, Asperger's Disorder, and

Pervasive Developmental Disorder-Not Otherwise Specified.

Best practices and intervention planning for individuals of

all ages are discussed.

Course Description

Course Objectives: By the end of this course the participant

will be able to:

Module 1 Objectives:

1. Define the term Autism Spectrum Disorders (ASD).

2. Name the three (3) primary conditions encompassed within the Autism Spectrum Disorders.

3. Discuss the common characteristics or indicators frequently seen inpersons with Autism Spectrum Disorders.

4. Distinguish the differences according to diagnostic criteria for Autistic Disorder, Asperger’s Disorder, and Pervasive DevelopmentalDisorder-NOS.

5. Discuss the causes of ASD.

6. Name the other medical conditions frequently seen in people with ASD.

Course Objectives: Module 1

Continued--

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Course Objectives: By the end of this course the participant

will be able to:

Module 2 Objectives:

1. Discuss key concepts in identifying and managing Autism Spectrum

Disorders.

2. Describe the screening and diagnostic evaluation process as they

relate to Autism Spectrum Disorders in children and adults.

3. Describe treatment options and common procedures for ASDs.

4. Discuss the best practice recommendations for children and adults

with ASDs.

Course Objectives: Module 2

TERMINOLOGY

Various terms related to resident care are used throughout

this course. While most of these terms are commonly

accepted in the industry, there is some variation from state

to state, and within different organizations.

To clarify these terms and to improve your understanding

of their meaning a brief explanation is provided on the

following two pages.

Continued--

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TERMINOLOGY, cont.

Terminology used in this course:

• Community: The care setting is referred to as an assisted living

or residential care community. Although the term "facility" is often

used in state regulations and by some in the industry, we feel it is

important to distinguish a group home, adult residential facility,

and/or an assisted living or residential care residence as a home,

rather than strictly a clinical facility.

– When the word "community" is used in this course it is referring

to the care setting, not the community at large. Clarification will

be provided if necessary. In some cases, such as when quotingfrom regulations, the term facility will be used.

Continued--

TERMINOLOGY, cont.

Terminology used in this course:

• Caregiver: This is the person providing care. Although there are

exceptions, typically this person is not a licensed medical

professional.

• Resident: The resident is the individual receiving care. In other

healthcare settings the term "patient" or "client" are more common,

but to foster a homelike atmosphere the term resident is used in the

assisted living and residential care industries.

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Additional Terminology

Autism: a spectrum disorder which encompasses a range of

neurological afflictions

ASD: autism spectrum disorders (may also be called autistic spectrum

disorders or pervasive developmental disorders)

PDD-NOS: pervasive developmental disorder-not otherwise specified

DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorder-

Fourth Edition, Text Revision

NIMH: National Institute of Mental Health

Let’s review the VERY IMPORTANT DIRECTIONS

before you get started:

• This course is self-paced. Feel free to take as much

time as you need to read each slide.

• You may go forward to the next slide or backwards to aprevious slide within this course.

Welcome!

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• Within this course may be some questions to help you

check your understanding. These questions are not

graded; they are included to help you with the

material.

• At the end of this course is a Final Exam to make

sure you understand the material. You must

complete the Exam to complete the course.

• This course starts with a pretest to help you assessyour knowledge. You must complete the pre-test

before beginning the instruction in the course.

More VERY IMPORTANT DIRECTIONS:

Module 1 IntroductionThis course is divided into two learning modules. In this

first module the information is presented in the following

section topics:

– Introduction

– Statistics

– Autism Spectrum Disorders: Definitions and Types

– Common Characteristics or Indicators of ASD

– History: Autistic Disorder

– History: Asperger’s Disorder

– Research: ASD and the Brain

– ASD and Other Problems

– ASD: Diagnostic Criteria

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INTRODUCTION

• Pervasive Developmental Disorders (PDDs) are also

known as Autism Spectrum Disorders (ASDs). In this

course we will be using the terms interchangeably.

• PDDs cause severe and pervasive impairment in

thinking, feeling, language, and the ability to relate to

others.

• PDDs are usually first diagnosed

in early childhood.

Introduction

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• The term Autism Spectrum Disorders includes five

separate conditions. The first three are the primary

ASDs:

– Autistic Disorder

– Asperger’s Disorder

– Pervasive Developmental Disorder - Not Otherwise

Specified (PDD-NOS)

• These conditions all have some of the same symptoms,but they differ in terms of when the symptoms start,

how severe they are, and the exact nature of the

symptoms.

Introduction, cont.

• The three primary ASDs listed on the previous page,

along with two rare conditions called Rett Syndrome and

Childhood Disintegrative Disorder, make up the broad

diagnosis category of Pervasive Developmental Disorders

(PDD) or Autism Spectrum Disorders (ASD).

Introduction, cont.

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• Autism is the most common of the five Autism Spectrum

Disorders (ASD).

• Although the classic form of autism can be easily

distinguished from other forms of autistic spectrum

disorders, the terms autism and autism spectrum

disorders are often used interchangeably.

Introduction, cont.

• In this course we will focus on the three most common

Autism Spectrum Disorders (ASD): Autism Disorder,

Asperger’s Disorder, and Pervasive Developmental

Disorder-NOS.

Introduction, cont.

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STATISTICS

• Estimates of the prevalence of autism vary widely

depending on diagnostic criteria, age of children

screened, and geographical location.

• State departments of education around the country are

reporting alarming increases in the numbers of children

receiving an autism diagnosis.

• One of the most hotly debated autism topics is whether

rates of incidence are actually rising or if improved

diagnostic techniques account for the rises seen

throughout the country.

Statistics

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• The number of reported cases of autism increased

dramatically in the 1990s and early 2000s, prompting

investigations into several potential reasons:

– More children may have autism; that is, the true frequency of

autism may have increased.

– There may be a more complete finding of cases as a result of

increased awareness and funding.

– The diagnosis may be applied more broadly than before as a

result of the changing definition of the disorder, particularly

changes in DSM-III-R and DSM-IV diagnostic criteria.

– Successively earlier diagnosis in each succeeding cohort of

children, including recognition in preschool, may have affected

apparent prevalence, but not incidence.

Statistics, cont.

• A 2009 study of California data found that the reportedincidence of autism rose 7- to 8-fold from the early1990s to 2007.

– Changes in diagnostic criteria, inclusion of mildercases, and earlier age of diagnosis probably explainonly a 4.25-fold increase.

– The study did not quantify the effects of wider

awareness of autism, increased funding, andexpanding treatment options resulting in parents'greater motivation to seek services.

Statistics, cont.

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• In summary, the reported increase is largely attributable

to changes in diagnostic practices, age at diagnosis, and

public awareness.

• But, these changes apparently do not account for all the

increase in prevalence that is seen.

• Researchers believe that the actual frequency of autismhas increased.

Statistics, cont.

• According to the Centers for Disease Control (February

2007), autism spectrum disorders affect approximately 1

in 150 children (6.6 per 100 children).

• ASD diagnosis commonly occurs between the ages of ten

(10) months and three (3) years of age, with a majority

of diagnoses taking place by the age of one.

Statistics, cont.

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• While ASD diagnosis most commonly occurs prior to the

age of three, there are some children who are not

properly diagnosed until they begin kindergarten at the

age of five (5) or later.

• Some cases of ASD may not be properly diagnosed until

adulthood, even late adulthood.

• Some cases may never be appropriately diagnosed.

Statistics, cont.

• In an effort to avoid these delayed diagnoses, families,

teachers, and others who care for children, especially

children considered at risk for ASD, are familiarized with

assessments, tools, guidelines, and best practices for

detecting ASD.

Statistics, cont.

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• A review of the literature demonstrates that statistical

estimates of the prevalence of ASDs do not always

agree.

– In 2005, the National Institute of Mental Health (NIMH) stated

the "best conservative estimate" as 1 in 1000 persons in the

United States.

– In 2007, the NIMH stated the "best conservative estimate" as 2-

6 in 1000 persons in the United States.

– And, as mentioned before, in 2007 the Centers for Disease

Control (CDC) estimated that ASDs may affect as many as 6.6

per 1000 in the United States.

Varying Autism Spectrum

Disorder Statistics

• Statistical variations aside, the one fact that everyone

agrees upon is that ASDs are being diagnosed with

increasing frequency.

Varying Autism SpectrumDisorder Statistics, cont.

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AUTISM SPECTRUM DISORDERS:

DEFINITIONS AND TYPES

• All autism spectrum disorders are life-long

neurodevelopmental disabilities characterized by:

– An onset of symptoms before 36 months (3 years) that

never “improve.”

• These symptoms remain constant in children and adults

(from young to aging).

Autism Spectrum Disorders(ASDs) Defined

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• All children and adults (including the elderly)

with ASDs demonstrate deficits in:

– Social interaction

– Verbal and non-verbal communications

– Repetitive or ritualistic behaviors or interests

Autism Spectrum Disorders

(ASDs) Defined, cont.

• They will often have unusual responses to sensory

experiences, such as certain sounds or the physical

appearance of certain objects.• Each of these symptoms runs the gamut from mild to

severe and will present differently in each individual

child, adult, and elderly adult.

• ASD’s impact varies significantly from individuals who

are nearly dysfunctional and apparently mentally

disabled to those whose symptoms are mild or remedied

enough to appear unexceptional ("normal") to others.

• Many "high-functioning" people of all ages and/or those

with a relatively high IQ suffering from ASD are under

diagnosed; thus, the assumption that ASD automatically

implies retardation is inaccurate.

Understanding Autism SpectrumDisorders, cont.

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• The five (5) Autism Spectrum Disorders, also known as

pervasive developmental disorders (PDDs), are shown

on the chart on the following slide.

Autism Spectrum Disorders

Autism Spectrum Disorders,cont.

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• The three primary ASDs that are closely related include:

1. Auti st ic D isorder

• Often referred to as:

– Classic Autism

– Traditional Autism

– Typical Autistic Disorder

– Kanner’s Disorder

2. Asperger ’s Disorder (or Asperger Syndrome)

3. Pervasive Developmental Disorder-Not OtherwiseSpecified (PDD-NOS)

• Also known as:

– Atypical Autistic Disorder

– Atypical PDD

Primary Types of Autism

Spectrum Disorders

• Two other ASDs that are rare include:

1 . Ret t Syndrome

• Rare type of ASD

• Not widely recognized by healthcare professionals

2. Chi ldhood Disintegrative Disorder

• Extremely rare type of ASD

• Not widely recognized by healthcare professionals

Rare Types of Autism SpectrumDisorders

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Check for Understanding

Based on Autism Spectrum Disorder Statistics,

reported in 2007 by the Centers of Disease Control,

persons in the United States who deal with some form

of Autistic Spectrum Disorder is:

A. 1 in 1000

B. 1 in a million

C. 1 in 150


Based on Autism Spectrum Disorder Statistics,

reported in 2007 by the Centers of Disease Control,

persons in the United States who deal with some form

of Autistic Spectrum Disorder is:

A. 1 in 1000

B. 1 in a million

C. 1 in 150

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COMMON CHARACTERISTICS OR

INDICATORS OF ASD

• The following pages list some of the behavioral characteristics

seen which can be possible indicators of ASDs in children

and/or adults.

• We have presented the characteristics according to age

group; however, many of these characteristics can be seen at

any age.

Common Characteristics orIndicators of ASD

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• Does not babble, point, or make meaningful gestures by

1 year of age

• Does not speak single words by 16 months

• Does not combine two words by 2 years

• Does not understand the concept of pointing - will look

at the hand pointing rather than object to which the

hand points

Possible Indicators of Autism Spectrum

Disorders in Children

Continued-

• Doesn't seem to know how to play with toys

• Excessively lines up toys or other objects

• Doesn't smile

• Consistently cries or absence of crying

• Failure to use 'I', 'me', and 'you', or reversal of these

pronouns

• Delayed toilet training• Limited development of play activities, particularly

imaginative play

Possible Indicators of Autism SpectrumDisorders in Children, cont.

Continued-

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• Likes to spin in a circle

• Overly active, uncooperative, or resistant

• Very independent, even at a very young age

• Gets things for himself/herself only


Disorders in Children, cont.

• Tunes others out – not interested in others – in his/her

“own world”

• Unusual attachments to toys, objects, or schedules

• Walks on his/her toes

• Unconcerned about - or completely oblivious to -

dangers around him/her (e.g., standing in the middle of

the street without worrying about getting hit by a car)

Possible Indicators of Autism SpectrumDisorders in Children and Adults

Continued-

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• Unusual responses to other people.

– Shows no desire to be cuddled or hugged

– Has a strong preference for familiar people and may

appear to treat people as objects rather than a source

of comfort.

• Marked repetitive movements, such as hand-shaking or

flapping, prolonged rocking or spinning of objects.


Disorders in Children and Adults, cont.

Continued-

• Extreme resistance to change in routines and/or environment

• Avoidance of social situations, preferring to be alone

• Sleeping problems

• Absence of speech, or unusual speech patterns such as

repeating words and phrases (echolalia)

– About half of the children who are non-verbal in the

preschool years will acquire some speech later in life

• Extreme distress caused by certain noises and/or busy public

places such as shopping centers

• Social judgments are difficult

– School behavior problems can often occur.

Possible Indicators of Autism SpectrumDisorders in Children and Adults, cont.

Continued-

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• Ritualistic and compulsive behavior patterns.

• Hyperactivity and a poor attention span are often observed,

usually because the child has trouble understanding

instructions from the teacher and classroom 'rules'.

• Significant levels of anxiety, often from the child's difficulty in

understanding other people and interpreting what is going on

around them.

• Many children will show a lack of motivation or desire to

please others.• Difficulty transferring skills learned in one setting to another

setting (e.g., school to home).



Continued-

• Cannot express or explain what he/she wants

• Does not respond to name

• Regresses in language or social skills

• Stares into open areas, not focusing on anything specific

• Poor eye contact

Possible Indicators of Autism SpectrumDisorders in Children and Adults, cont.

Continued-

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• Doesn’t follow directions

• Has odd movement patterns

• Throws tense or violent tantrums

• Often puts hands on ears

• At times seems to be hearing impaired



• Normal adolescent behavioral challenges and broad mood

fluctuations are exaggerated for those with an Autism

Spectrum Disorder.

– It may start a little later than “normal adolescence” and continue

into late teens and early twenties, but eventually there is a

resumption of calmer behavior.

• A few adolescents show marked improvement in their

behavior and skills, while others may show serious behavioral

regression.

• Sexual development and interest varies with physical

development, but in general is delayed.

Possible Indicators of Autism SpectrumDisorders in Adolescents and Adults

Continued-

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• The commencement of menstruation and sexual drive are

usually tolerated calmly, but exhibitionism and public

masturbation are sometimes problems.

– This behavior can usually be redirected using behavior

modification techniques.

• The presence of a disability seems to become more obvious in

the physical appearance of the older person, especially if they

also have an intellectual disability.

• Epilepsy or seizures may develop in a number of adolescentswith an Autism Spectrum Disorder.

Possible Indicators of Autism SpectrumDisorders in Adolescents and Adults, cont.

Continued-

• Increased levels of anxiety and the development of

depressive symptoms often occur.

– Caregivers need to be alert to this and seek professional

supports for the person.

– Psychotropic medication, as prescribed by a psychiatrist, can

assist with anxiety management.

• If they have received specialist intervention, adults with an

Autism Spectrum Disorder are able to partly overcome theirdifficulties but continue to require sensitive and sustained

support, usually from their families.

Possible Indicators of Autism SpectrumDisorders in Adolescents and Adults, cont.

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• Keep in mind that no ratios are clear-cut in those with

ASD:

– Intellectual disability occurs in at least 70%

– More common in males than females (3:1)

– An accompanying condition of epilepsy is common and can

onset at any age

– Anxiety is common, due to poor communication skills,

over-stimulation, etc.

– May develop behavior disorders

Other Common Characteristics


Possible indicators of Autism Spectrum Disorders

in children and adults include all of the following

except:

A. Walks on his/her toes

B. Smiles all the time and loves to have

conversations with peers

C. Doesn’t seem to know how to play with toys

D. Often puts hands on ears

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Possible indicators of Autism Spectrum Disorders

in children and adults include all of the following

except:

A. Walks on his/her toes

B. Smiles all the time and loves to have

conversations with peers

C. Doesn’t seem to know how to play with toys

D. Often puts hands on ears

HISTORY: AUTISTIC DISORDER

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• The word "autism" was first used in the English language

in a 1911 issue of the American Journal of Insanity.

• The term was originally used to talk about people who

seemed to have very little social communication with

others.

• Autism was actually confused with schizophrenia during

the early stages of observation.

History of Autistic Disorder

Continued-

• Historically, many behaviors displayed by blind and deaf

children and adults (including the elderly) were seen as

"autistic-like" and attributed to their blindness or

deafness, rather than considering the possibility of

Autism Spectrum Disorders.

History of Autistic Disorder,cont.

Continued-

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Dr. Leo Kanner was an Austrian psychiatrist and

physician. He emigrated to the U.S. in 1924 and became

an Associate Professor of Psychiatry at Johns Hopkins

Hospital in 1933. Dr. Kanner is considered the creator of

the autism classification and published his first paper

identifying autistic children in 1943.

History of Autistic Disorder,

cont.

Continued-

• The classification of “autism” as a separate disorder or

disease did not occur until after Dr. Kanner’s 1943 paper

that suggested the term "autism" to describe the fact

that the children seemed to lack interest in other people.

• Almost every characteristic originally described by Dr.

Kanner is still regarded as typical of the autistic

spectrum of disorders.

History of Autistic Disorder,cont.

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HISTORY: ASPERGER’S DISORDER

• At the same time Dr. Kanner was making his discoveries,

an Austrian scientist named Dr. Hans Asperger made

similar observations, although his name has since

become attached to a different, higher-functioning form

of ASD, known as Asperger syndrome.

History of Asperger’s Disorder

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Dr. Hans Asperger was born on a farm outside of Vienna, earned

his medical degree in 1931, and spent 20 years as the Chair of

Pediatrics at the University of Vienna. In the 1940s, Dr. Hans

Asperger published the first definition of Asperger syndrome in

1944. Dr. Asperger's findings were largely ignored and

disregarded in his lifetime. Finally, in the early 1990s his findings

began to gain notice, and today Asperger syndrome is recognized

as a diagnosis in a large part of the world.

History of Asperger’s Disorder,

cont.

Continued-

• Asperger’s Disorder is diagnosed by the presence of

social interaction impairments and repetitive and

restricted interests.

• There is usually no significant language delay, yet there

are impairments in the social use of language – often

leading to isolation.

• This disorder is more common in males (13:1)*.

*Note: this disorder may be under-diagnosed in females.

Asperger’s Disorder

Continued-

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• While the DSM-IV-TR does not include level of

intellectual functioning in the diagnosis, those with

Asperger's syndrome tend to function better than those

with Autistic Disorder.

• People with Asperger’s Syndrome often have a great

discrepancy between their intellectual and social abilities.

• This fact has produced a popular conception that

Asperger's Syndrome is synonymous with "higher-

functioning autism," or that it is a lesser disorder than

autism.

Asperger’s Disorder, cont.

Continued-

• Children and adults with Asperger Syndrome generally

have few facial expressions apart from anger or misery.

• Most have excellent rote memory and musical ability,

and become intensely interested in one or two subjects

(sometimes to the exclusion of other topics).


Continued-

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• People with this disorder may talk at length about a

favorite subject or repeat a word or phrase many times.

• Children and adults with Asperger’s Syndrome tend to be

"in their own world" and preoccupied with their own

agenda.

• The onset of Asperger’s Syndrome commonly occurs

after the age of three (3).


Continued-

• Some individuals who exhibit features of autism, but

who have well-developed language skills, may be

diagnosed with Asperger’s Syndrome.

• Children with Asperger’s Syndrome have a better

prognosis than those with other pervasive developmental

disorders and are much more likely to grow up to be

independently functioning adults.


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• Clumsiness

• Concrete, pedantic speech (a narrow, often tiresome

focus on or display of book learning and formal rules)

• Lack of common sense

• Intolerance of change

• Anxiety

ypical Characteristics of Asperger’s Disorder in Children and

Adults

• Asperger’s Disorder is thought to be under-diagnosed in

many adults and the elderly.

• The Cambridge Lifespan Asperger Syndrome Service

(CLASS), an organization in the United Kingdom that

works with adults with Asperger's, has developed a

simple ten question checklist to identify the possible

presence of Asperger’s.

Asperger’s Disorder in Adults/Elderly

Continued-

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CLASS checklist, cont.

• Individuals answering “yes” to some or most of these

questions, should consider obtaining input from a

medical professional.

I find social situations confusing.

I find it hard to make small talk.

I did not enjoy imaginative story-writing at school.

I am good at picking up details and facts.

Asperger’s Disorder in

Adults/Elderly, cont.

Continued-

CLASS checklist, cont.

I find it hard to work out what other people are

thinking and feeling.

I can focus on certain things for very long periods.

People often say I was rude even when this was not

intended.

I have unusually strong, narrow interests. I do certain things in an inflexible, repetitive way.

I have always had difficulty making friends.

Asperger’s Disorder in Adults/Elderly, cont.

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• The third primary ASD is Pervasive Developmental

Disorder—Not Otherwise Specified.

• Pervasive Developmental Disorder–Not Otherwise

Specified is included in DSM-IV–TR to encompass cases

where there is marked impairment of social interaction,

communication, and/or stereotyped behavior patterns or

interest, but when full features for another explicitly

defined PDD are not met.

PDD-NOS Defined

Criteria

– Core autistic behaviors are present

– Full criteria for Autistic Disorder or another PDD is not

met

Management

– Management of PDD-NOS is the same as Autistic

Disorder

PDD-NOS Criteria & Management

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• Although PDD-NOS is a well-recognized form of ASD,

studies on PDD-NOS are less common than those on

Asperger’s Disorder and Autistic Disorder.

• PDD-NOS has less diagnostic research on it than any

other ASD.

PDD-NOS Information


The following disorder is more common in malesand has a popular conception of being a “higher-functioning autism”, or at least a lesser autisticdisorder.

A. Rett’s Disorder

B. Kanner’s Disorder

C. Childhood Disintegrative Disorder

D. Asperger’s Disorder

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The following disorder is more common in malesand has a popular conception of being a “higher-functioning autism”, or at least a lesser autisticdisorder.

A. Rett’s Disorder

B. Kanner’s Disorder

C. Childhood Disintegrative Disorder

D. Asperger’s Disorder

RESEARCH: ASD AND THE BRAIN

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• There is no known single cause for autism.

• It is generally accepted that autism is caused by

abnormalities in brain structure or function. Brain scans

show differences in the shape and structure of the brain

in children with autism versus non-autistic children.

• Researchers are investigating a number of theories,

including the link between heredity, genetics and

medical problems.

Causes of ASD

• Autism does not have a clear unifying mechanism at

either the molecular, cellular, or systems level; it is not

known whether autism is a few disorders caused by

mutations converging on a few common molecular

pathways, or is (like intellectual disability) a large set of

disorders with diverse mechanisms.

Causes of ASD, cont.

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• Because of its relative inaccessibility, scientists have only

recently been able to study the brain systematically. But

with the emergence of new brain imaging tools the study

of the structure and the functioning of the brain can now

be done.

• Postmortem and MRI studies have shown that many

major brain structures are implicated in autism. This

includes the cerebellum, cerebral cortex, limbic system,

corpus callosum, basal ganglia, and brain stem. Otherresearch is focusing on the role of neurotransmitters

such as serotonin, dopamine, and epinephrine.

Research

• ASD affects many parts of the brain.

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Major Brain Structures Implicated in

Autism, cont.

• Recent neuroimaging studies have shown that a

contributing cause for autism may be abnormal brain

development beginning in the infant’s first months. This

“growth dysregulation hypothesis” holds that the

anatomical abnormalities seen in autism are caused by

genetic defects in brain growth factors.

• Autism appears to result from developmental factors that

affect many or all functional brain systems, and to

disturb the timing of brain development more than the

final product.

ASD and The Brain

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• The heads of children with ASD tend to be “larger than

what is considered normal” and researchers confirm that

these children have bigger and heavier brains than those

children without ASD.

– This occurs at the 1-2 month mark, as babies with ASD are born

with smaller heads, but they rapidly grow.

– It is possible that sudden, rapid head growth in an infant may be

an early warning signal that will lead to early diagnosis and

effective biological intervention or possible prevention of autism.

• By the age 18, the brain in a majority of people with

ASD is of normal weight.

ASD and The Brain, cont.

• Research into the causes of autism spectrum disorders is

being fueled by other recent developments. Evidence

points to genetic factors playing a prominent role in the

causes for ASD. Twin and family studies have suggested

an underlying genetic vulnerability to ASD.

ASD and Genetics

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• The Institute of Medicine (IOM) conducted a thorough

review on the issue of a link between thimerosal (a

mercury based preservative that is no longer used in

vaccinations) and autism. The final report from IOM,

Immunization Safety Review: Vaccines and Autism,

released in May 2004, stated that the committee did not

find a link.

ASD and Vaccines

• A U.S. study looking at environmental factors including

exposure to mercury, lead, and other heavy metals is

ongoing.

ASD and Environmental Factors

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• Much of ASD remains a mystery, and some researchers

are focusing on environmental factors, as others

continue to investigate genetics. Current theory holds

that ASD results from a combination of genetics and

environmental factors.

Causes of ASD


Based on research, which of the followingstatements is false?

A.No single cause for ASD is known

B.Environmental factors are being studied to determine

their role in ASD

C.Genetic factors are thought to pay a role in the causes of

ASD

D.None; all of the above are true

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Based on research, which of the followingstatements is false?

A.No single cause for ASD is known

B.Environmental factors are being studied to determine

their role in ASD

C.Genetic factors are thought to pay a role in the causes of

ASD

D.None; all of the above are true

ASD AND OTHER PROBLEMS

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• People who have ASD often have other medical or

behavioral problems. Some of the most common are

described in this section.

ASD and Other Problems

• Sensory problems. Many ASD children are highly attuned or even

painfully sensitive to certain sounds, textures, tastes, and smells. In

ASD, the brain seems unable to balance the senses appropriately.

– Some children find the feel of clothes touching their skin almost

unbearable.

– Some sounds—a vacuum cleaner, a ringing telephone, a sudden

storm, even the sound of waves lapping the shoreline—will

cause these children to cover their ears and scream.

– Some ASD children are oblivious to extreme cold or pain.

– An ASD child may fall and break an arm, yet never cry. Another

may bash his head against a wall and not wince, but a light

touch may make the child scream with alarm.

ASD and Other Problems, cont.

Continued--

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• Mental retardation. Many children with ASD have

some degree of mental impairment.

• Seizures. One in four children with ASD

develops seizures, often starting either

in early childhood or adolescence.


Continued--

• Tuberous Sclerosis. Tuberous sclerosis is a rare

genetic disorder that causes benign tumors to grow in

the brain as well as in other vital organs. It has a

consistently strong association with ASD. One to 4

percent of people with ASD also have tuberous sclerosis.


Continued--

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• Fragile X syndrome. This disorder is the most

common inherited form of mental retardation. It was so

named because one part of the X chromosome has a

defective piece that appears pinched and fragile when

under a microscope. Fragile X syndrome affects about

two to five percent of people with ASD. It is important to

have a child with ASD checked for Fragile X, especially if

the parents are considering having another child.


ASD: DIAGNOSTIC CRITERIA

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• Accurate diagnosis of Autism Spectrum Disorder is

important for a number of reasons, including:

– Assessment can assist in understanding why someone

is “different” and understand his/her strengths,

challenges, and needs

– Early intervention and appropriate educational

programs can be implemented

– Access to support services can be facilitated

Diagnosis of ASD

• Common difficulties encountered with the management

of ASD in children and adults are:

– Difficult behavior, such as tantrums, obsessions,

aggression, etc.

– Communication problems

– Disturbed routine, such as sleep or finicky eating

– Social issues such as inappropriate behavior, isolation,

teasing, bullying, etc.

Influences in Behavior

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• The Diagnostic and Statistical Manual of Mental Disorder

– Fourth Edition (DSM-IV-TR), published by the

American Psychiatric Association, Washington, D.C. is

the main diagnostic reference of mental health

professionals in the United States.

• The DSM-IV-TR outlines specific diagnostic criteria for

each of the five Autism Spectrum Disorders (ASDs), also

called Pervasive Developmental Disorders (PDDs).

DSM-IV-TR Criteria

• All of the Pervasive Developmental Disorders are

characterized by severe and pervasive impairment in

several areas of development including:

1. reciprocal social interaction skills

2. communication skills, or

3. the presence of stereotyped behavior, interests, and

activities.• The qualitative impairment that define the different ASD

conditions are described in the following pages.

All PDDs

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• The following pages present the specific diagnostic

criteria that is found in the DSM-IV-TR for all 5 of the

Autism Spectrum Disorders.

Diagnostic Criteria

A. A total of six (or more) items from (1), (2), and (3), with at

least two from (1), and one each from (2) and (3):

(1) Qualitative impairment in social interaction as manifested 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 to regulate social interaction.

b) Failure to develop peer relationships appropriate to

developmental level.

c) Lack of spontaneous seeking to share enjoyment, interests, or

achievements with other people.

d) Lack of social or emotional reciprocity.

DSM-IV-TR Criteria299.00 Autistic Disorder

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(2) Qualitative impairments in communication, as manifested

by at least one of the following:

a) Delay in, or total lack of, the development of spoken language

(not accompanied by an attempt to compensate through

alternative modes of communication such as gesture or mime).

b) In individuals with adequate speech, marked impairment in the

ability to initiate or sustain a conversation with others.

c) Stereotyped and repetitive use of language or idiosyncratic

language.

d) Lack of varied, spontaneous make-believe play or social imitative

play appropriate to developmental level.

DSM-IV-TR Criteria

299.00 Autistic Disorder, cont.

(3) Restrictive, repetitive, and stereotyped patterns of

behavior, interests, and activities as manifested by at least

one of the following:

a) Encompassing preoccupation with one or more stereotyped and

restricted patterns of interest that is abnormal either in intensity

or focus.

b) Apparently inflexibility adherence to specific, nonfunctional

routines or rituals.

c) Stereotyped and repetitive motor mannerisms.

d) Persistent preoccupation with parts of objects.

DSM-IV-TR Criteria299.00 Autistic Disorder, cont.

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B. Delays or abnormal functioning in at least one of the

following areas, with onset prior to age three years:

– Social interaction

– Language as used in social communication

– Symbiotic or imaginative play

C. The disturbance is not better accounted for by Rett’s

Disorder or Childhood Disintegrative Disorder.

DSM-IV-TR Criteria

299.00 Autistic Disorder, cont.

All areas must be met to qualify:

(1) Qualitative impairment in social interaction as

manifested 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 to regulate social interaction.

b) Failure to develop peer relationships appropriate to

developmental level.c) Lack of spontaneous seeking to share enjoyment, interests, or

achievements with other people.

d) Lack of social or emotional reciprocity.

DSM-IV-TR Criteria299.80 Asperger’s Disorder

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(2) Restrictive, repetitive, and stereotyped patterns of

behavior, interests, and activities as manifested by at

least one of the following:

a) Encompassing preoccupation with one or more stereotyped and

restricted patterns of interest that is abnormal either in intensity

or focus.

b) Apparently inflexibility adherence to specific, nonfunctional

routines or rituals.

c) Stereotyped and repetitive motor mannerisms.

d) Persistent preoccupation with parts of objects.

DSM-IV-TR Criteria

299.80 Asperger’s Disorder, cont.

(3) The disturbance causes clinically significant impairment in

social, occupational, or other important areas of

functioning.

(4) There is no clinically significant general delay in language

(e.g. single words used by age 2 years, communicative

phrases used by age 3 years).

(5) There is no clinically significant delay in cognitive

development or in the development of age-appropriateself-help skills, adaptive behavior (other than in social

interaction), and curiosity about the environment in

childhood.

(6) Criteria are not met for another specific pervasive

developmental disorder or schizophrenia.

DSM-IV-TR Criteria299.80 Asperger’s Disorder, cont.

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• This category should be used when there is a severe and

pervasive impairment in the development of reciprocal

social interaction associated with impairment in either

verbal and nonverbal communication skills, or with the

presence of stereotyped behavior, interests, and

activities, but the criteria are not met for a specific

pervasive developmental disorder, schizophrenia,

schizotypal personality disorder, or avoidant personality

disorder.

DSM-IV-TR Criteria - 299.80 PervasiveDevelopmental Disorder, Not Otherwise

Specified (PDD-NOS)

A. All areas must be met to qualify:

1. Apparently normal prenatal and perinatal development.

2. Apparently normal psychomotor development through

the first 5 months after birth.

3. Normal head circumference at birth.

DSM-IV-TR Criteria299.80 Rett’s Disorder

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B. Onset of all of the following after the period of normal

development:

1. Declaration of head growth between ages 5-48 months.

2. Loss of previously acquired purposeful hand skills between

ages 5-30 months with the subsequent development of

stereotyped hand movements (e.g., hand-wringing or hand

washing).

3. Loss of social engagement early in the course (although social

interaction often develops later).

4. Appearance of poorly coordinated gait or trunk movements.

5. Severely impaired expressive and receptive language

development with severe psychomotor retardation.

DSM-IV-TR Criteria

299.80 Rett’s Disorder, cont.

A. Apparently normal development for at least the first 2 years after

birth as manifested by the presence of age-appropriate verbal and

non-verbal communication, social relationships, play, and adaptive

behavior.

B. Clinically significant loss of previously acquired skills (before age 10

years) in at least two of the following areas:

1. Expressive or repetitive language

2. Social skills or adaptive behavior

3. Bowel or bladder control

4. Play

5. Motor skills

DSM-IV-TR Criteria - 299.10Childhood Disintegrative Disorder

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C. Abnormalities of functioning in at least two of the following

areas:

1. Qualitative impairment in social interaction (e.g. impairment innonverbal behaviors, failure to develop peer relationships, lack of social or emotional reciprocity).

2. Qualitative impairments in communication (e.g. delay or lack of spoken language, inability to initiate or sustain a conversation,stereotyped and repetitive use of language, lack of varied make-believe play).

3. Restricted, repetitive, and stereotyped patterns of behavior,

interests, and activities, including motor stereotypes andmannerisms.

D. The disturbance is not better accounted for by another specific

pervasive developmental disorder or by schizophrenia.

DSM-IV-TR Criteria - 299.10 Childhood

Disintegrative Disorder, cont.

• As previously noted in this presentation – please

remember that there is much to learn about ASD and

that the information presented is the best available at

this time.

Disclaimer Notice

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• This is the end of the information in Module 1.

• In this module you learned:

– The terminology, definitions, and the five conditions associatedwith Autism Spectrum Disorders (ASD).

– Common characteristics or indicators frequently seen in personswith Autism Spectrum Disorders.

– The differences in diagnostic criteria for each of the five ASDs.

– The causes of ASD.

– Other medical conditions frequently seen in people with ASD.

Summary: Module 1

Module 2 Content

In Module 2 we will build upon the information you learned

in this module. In Module 2 we will discuss:

– Key concepts in identifying and managing Autism Spectrum

Disorders.

– The screening and diagnostic evaluation process as they relate

to Autism Spectrum Disorders in children and adults.

– Treatment options and common procedures for ASDs.

– Best practice recommendations for children and adults with

ASDs.

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Module 1 Completed

• This is the end of Module 1

• Next, you will begin Module 2

• If you feel you are ready, please close this window and

proceed to Module 2 from the main Curriculum Contents

window.

Autism M01

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Transcript of Autism M01