Autism Spectrum DisorderAutism Spectrum Disorder

ECED 2060ECED 2060

Disability Category Disability Category PresentationPresentation

1943 – Dr. Leo Kanner1943 – Dr. Leo Kanner

• Johns Hopkins Johns Hopkins University University HospitalHospital

• 11 patients with 11 patients with similar similar characteristicscharacteristics

• Coined term Coined term “early infantile “early infantile autism”autism”

Dr. Hans AspergerDr. Hans Asperger

• About the same About the same time as Dr. Kanner time as Dr. Kanner in USAin USA

• GermanyGermany• Described a milder Described a milder

form of autism, form of autism, now known as now known as “Asperger “Asperger Syndrome”Syndrome”

NOW called AUTISM NOW called AUTISM SPECTRUM DISORDERSPECTRUM DISORDER

• Five separate disorders in the spectrumFive separate disorders in the spectrum• Formerly called Pervasive Formerly called Pervasive

Developmental DisordersDevelopmental Disorders• DSM IV lists 5; but closely related is DSM IV lists 5; but closely related is

childhood schizophreniachildhood schizophrenia

IDEA Definition of IDEA Definition of AUTISMAUTISM

• ““Autism means a developmental Autism means a developmental disability significantly affecting disability significantly affecting verbal and nonverbal verbal and nonverbal communication and social communication and social interaction, generally evident interaction, generally evident before age 3, that adversely before age 3, that adversely affects educational performance. affects educational performance. Characteristics of autism include Characteristics of autism include irregularities and impairments in irregularities and impairments in communication, engagement in communication, engagement in repetitive activities and repetitive activities and stereotyped movements, stereotyped movements, resistance to environmental resistance to environmental change or change in daily change or change in daily routines, and unusual responses routines, and unusual responses to sensory experiences.”to sensory experiences.”

THE FIVE DISORDERS THE FIVE DISORDERS of Autism Spectrum of Autism Spectrum

DisorderDisorder

• AUTISTIC DISORDERAUTISTIC DISORDER• RETT SYNDROMERETT SYNDROME• CHILDHOOD DISINTEGRATIVE CHILDHOOD DISINTEGRATIVE

DISORDERDISORDER• PERVASIVE DEVELOPMENTAL PERVASIVE DEVELOPMENTAL

DISORDER- NOT OTHERWISE DISORDER- NOT OTHERWISE SPECIFIED (PDD-NOS)SPECIFIED (PDD-NOS)

• ASPERGER SYNDROMEASPERGER SYNDROME

Autism Spectrum Disorder Autism Spectrum Disorder StatisticsStatistics

• Estimated ~ 1 per 150 children (1/94 Estimated ~ 1 per 150 children (1/94 boys)boys)

• Generally reliably diagnosed by age 3Generally reliably diagnosed by age 3• Sometimes apparent much earlierSometimes apparent much earlier• Deficits in social interaction, verbal Deficits in social interaction, verbal

and nonverbal communication, and and nonverbal communication, and repetitive behaviors and interestsrepetitive behaviors and interests

Possible Indicators . . .Possible Indicators . . .

• Does not babble, point, or make Does not babble, point, or make meaningful gestures by age 1meaningful gestures by age 1

• Does not speak one word by 16 monthsDoes not speak one word by 16 months• Does not combine 2 words by 2 yearsDoes not combine 2 words by 2 years• Does not respond to nameDoes not respond to name• Loses language or social skillsLoses language or social skills• No big smiles or other warm, joyful No big smiles or other warm, joyful

expressions by 6 months of ageexpressions by 6 months of age• No back and forth sharing of sounds, No back and forth sharing of sounds,

smiles, or other facial expressions by 9 smiles, or other facial expressions by 9 monthsmonths

Some other possible Some other possible indicatorsindicators

• Poor eye contactPoor eye contact• Doesn’t seem to know how to play with Doesn’t seem to know how to play with

toystoys• Compulsively lines up toys or objectsCompulsively lines up toys or objects• Is attached to one particular toy or objectIs attached to one particular toy or object• Doesn’t smileDoesn’t smile• At times seems to be hearing impairedAt times seems to be hearing impaired• No gesturing, such as pointing, showing, No gesturing, such as pointing, showing,

reaching, waving by 12 monthsreaching, waving by 12 months• No pretend play by 18 monthsNo pretend play by 18 months

More indicators . . .More indicators . . .

• Stiff, or resistant to hugs or to cuddlingStiff, or resistant to hugs or to cuddling• Seldom seeks comfort or responds to angerSeldom seeks comfort or responds to anger• Difficulty regulating emotionsDifficulty regulating emotions• Repetitive, self-stimulating motions, such as Repetitive, self-stimulating motions, such as

hand-flapping, head banging …hand-flapping, head banging …• Extreme reaction to changes in environment Extreme reaction to changes in environment

or scheduleor schedule• At ANY age, loss of speech, babbling, motor At ANY age, loss of speech, babbling, motor

skillsskills• Acute sensitivity to touch, taste, noise, smellsAcute sensitivity to touch, taste, noise, smells• Odd use of the eyesOdd use of the eyes

AUTISTIC DISORDERAUTISTIC DISORDER

• Four times more Four times more common in boyscommon in boys

• Moderate to severeModerate to severe• Many also have Many also have

mental retardationmental retardation• Sometimes referred Sometimes referred

to as childhood to as childhood autism or early autism or early infantile autisminfantile autism

RETT SYNDROMERETT SYNDROME

• Neurological disorderNeurological disorder• Caused by a defective Caused by a defective

regulatory MECP2 gene, regulatory MECP2 gene, found on the X found on the X chromosome.chromosome.

• Gene discovery Gene discovery announced 10/1/99 by announced 10/1/99 by scientists at Baylor scientists at Baylor College of Medicine.College of Medicine.

• Lifespan ~ 47 years . . . Lifespan ~ 47 years . . .

Rett Syndrome, Rett Syndrome, continuedcontinued

• Occurs 1 in 10,000 to 1 Occurs 1 in 10,000 to 1 in 23,000 female birthsin 23,000 female births

• First discovered by Dr. First discovered by Dr. Andreas Rett in 1964.Andreas Rett in 1964.

• Development normal Development normal until 6 – 18 months, until 6 – 18 months, followed by loss of followed by loss of speech and hand skills, speech and hand skills, slowing of head growth, slowing of head growth, and development of and development of stereotyped hand stereotyped hand movements . . . movements . . .

Rett Syndrome, continued Rett Syndrome, continued . . . .

• SeizuresSeizures• Breathing Breathing

irregularities irregularities • ScoliosisScoliosis• Teeth grindingTeeth grinding• Poor circulationPoor circulation• Trouble sleeping Trouble sleeping • IrritabilityIrritability• Difficulty chewing and Difficulty chewing and

swallowingswallowing• TremblingTrembling

Childhood Disintegrative Childhood Disintegrative DisorderDisorder

• Fewer than 2 per Fewer than 2 per 100,000 children 100,000 children diagnosed with ASD diagnosed with ASD could be classified as could be classified as having CDD.having CDD.

• Two or more years of Two or more years of apparently normal apparently normal developmentdevelopment

• Average age of onset Average age of onset 3—4 years3—4 years

• Strong male Strong male preponderancepreponderance

CDD, continued . . .CDD, continued . . . • Extensive and Extensive and

pronounced losses in pronounced losses in motor, language, and motor, language, and social skillssocial skills

• Loss of bowel and Loss of bowel and bladder controlbladder control

• Usually accompanied Usually accompanied by severe mental by severe mental retardationretardation

• Often accompanied Often accompanied by seizuresby seizures

Pervasive Developmental Disorder Pervasive Developmental Disorder – Not Otherwise Specified (PDD-– Not Otherwise Specified (PDD-

NOS)NOS)• According to the DSM IV, this diagnosis According to the DSM IV, this diagnosis

should be used “when there is a severe and should be used “when there is a severe and pervasive impairment in the development of pervasive impairment in the development of social interaction and verbal and nonverbal social interaction and verbal and nonverbal communication skills, or when stereotyped communication skills, or when stereotyped behaviors, interests and activities are behaviors, interests and activities are present, but the criteria are not met for a present, but the criteria are not met for a specific Pervasive Developmental disorder, specific Pervasive Developmental disorder, schizophrenia, Schizotypal Personality schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder.”Disorder, or Avoidant Personality Disorder.”

PDD-NOS . . .PDD-NOS . . .

• . . . In other words, . . . In other words, sounds like ASD, tastes sounds like ASD, tastes like ASD, but doesn’t like ASD, but doesn’t quite fit any other part quite fit any other part of ASD . . .of ASD . . .

• No set criteria in DSM IV No set criteria in DSM IV for diagnosing PDD-NOSfor diagnosing PDD-NOS

• No medical test No medical test availableavailable

• Diagnosis usually a Diagnosis usually a clinician’s ‘best guess’clinician’s ‘best guess’

Asperger SyndromeAsperger Syndrome

• Also referred to as Also referred to as Asperger’s Asperger’s Syndrome or Syndrome or Asperger’s Asperger’s DisorderDisorder

• Mildest of the five Mildest of the five disorders in the disorders in the spectrumspectrum

• Incorrectly called Incorrectly called “high-functioning “high-functioning autism” sometimesautism” sometimes

Indicators of Asperger Indicators of Asperger SyndromeSyndrome

• Lack of social skillsLack of social skills• Poor coordinationPoor coordination• Poor concentrationPoor concentration• Normal intelligenceNormal intelligence• Adequate language Adequate language

skillsskills• Repetitive and Repetitive and

stereotyped stereotyped behaviorsbehaviors

Other disorders with Other disorders with symptoms that mirror symptoms that mirror

AutismAutism• William SyndromeWilliam Syndrome• Landau-Kleffner Landau-Kleffner

SyndromeSyndrome• Attention Deficit DisorderAttention Deficit Disorder• Language disorders, such Language disorders, such

as apraxia and hyperlexiaas apraxia and hyperlexia• Mobius syndromeMobius syndrome• Joubert syndromeJoubert syndrome• Down SyndromeDown Syndrome• CHARGE syndromeCHARGE syndrome• Smith-Lemli-Opitz Smith-Lemli-Opitz

syndromesyndrome

Other disorders …Other disorders …

• Angelman Angelman Syndrome, Prader-Syndrome, Prader-Willi Syndrome Willi Syndrome (both due to (both due to problems on problems on chromosome pair 15) chromosome pair 15) – some children with – some children with autism also have autism also have problems on problems on chromosome 15. The chromosome 15. The disorders also have disorders also have symptoms similar to symptoms similar to autism.autism.

• Fragile X Syndrome:Fragile X Syndrome: Most common form of Most common form of inherited mental inherited mental retardation – affects 2% retardation – affects 2% to 5% of children with to 5% of children with ASD.ASD.

• Tuberous Sclerosis:Tuberous Sclerosis: a a rare genetic disorder rare genetic disorder that causes benign that causes benign tumors to grow in the tumors to grow in the brain and other organs. brain and other organs. 1% to 4% of children 1% to 4% of children with ASD also have this.with ASD also have this.

Problems That May Problems That May ACCOMPANY autismACCOMPANY autism

• Sensory problems:Sensory problems: generally highly generally highly sensitive to sounds, sensitive to sounds, textures, tastes, textures, tastes, smells, etc. (see next smells, etc. (see next slide)slide)

• Mental Retardation:Mental Retardation: Many have some Many have some degree of mental degree of mental impairmentimpairment

• Epilepsy:Epilepsy: One in four One in four children with ASD children with ASD develops seizures; also develops seizures; also risk for abnormal EEG risk for abnormal EEG without seizures.without seizures.

• Learning Learning disabilities: disabilities: mainly mainly in cognition tasksin cognition tasks

• Tics: Tics: ~9% of children ~9% of children with autism.with autism.

• Sleep disorders: Sleep disorders: 50% to 70% of 50% to 70% of children with autism.children with autism.

• Gastrointestinal Gastrointestinal symptomssymptoms

• Psychiatric Psychiatric conditionsconditions

Sensory Symptoms -- Sensory Symptoms -- AUDITORYAUDITORY

• Difficulty processing Difficulty processing auditory informationauditory information

• Central Auditory Central Auditory Processing Disorder Processing Disorder (CAPD) – difficulty (CAPD) – difficulty discriminating discriminating foreground from foreground from background noise; background noise; distortions of speech distortions of speech sounds, lag time in sounds, lag time in processing speechprocessing speech

Sensory Symptoms – Sensory Symptoms – VISUALVISUAL

• Visual perceptual Visual perceptual problems, such as problems, such as tunnel vision, reliance tunnel vision, reliance on peripheral vision, on peripheral vision, difficulty telling difficulty telling foreground from foreground from backgroundbackground

• Sensitivity to lightSensitivity to light• Inability to focus on Inability to focus on

changing visualschanging visuals• Visual overloadVisual overload• Inability to look and Inability to look and

listen at the same timelisten at the same time

Sensory Symptoms – SMELL Sensory Symptoms – SMELL and FOOD ALLERGIESand FOOD ALLERGIES

• Because of sensitivity Because of sensitivity to smell some children to smell some children with ASD may refuse with ASD may refuse to eat certain foods, to eat certain foods, go to a zoo, sit in the go to a zoo, sit in the cafeteria, go to a farm, cafeteria, go to a farm, etc. Other odors may etc. Other odors may trigger sensitivities.trigger sensitivities.

• Children with autism Children with autism are more likely than are more likely than the average child to the average child to have food allergies.have food allergies.

Sensory Symptoms -- Sensory Symptoms -- TOUCHTOUCH

• One of the earliest signs of One of the earliest signs of autism is observed in autism is observed in babies who scream when babies who scream when they are touched or they are touched or hugged.hugged.

• Light touch may be painfulLight touch may be painful• Touch may cause anxietyTouch may cause anxiety• Clothing can feel torturousClothing can feel torturous• Deep pressure is tolerated Deep pressure is tolerated

very wellvery well• Self-stimulating behaviorsSelf-stimulating behaviors

Some theories on the Some theories on the cause of AUTISM . . . 1. cause of AUTISM . . . 1.

BettelheimBettelheim

• Mother’s extreme Mother’s extreme hatred for the child – hatred for the child – her wish that he/she her wish that he/she would just die.would just die.

• ““Refrigerator Refrigerator mothers” and absent mothers” and absent fathersfathers

• --Dr. Bruno --Dr. Bruno BettelheimBettelheim

Some theories on the Some theories on the cause of AUTISM . . . 2. cause of AUTISM . . . 2.

Child’s DietChild’s Diet

• Food allergies maybeFood allergies maybe• Insufficiency of certain Insufficiency of certain

vitamins maybevitamins maybe• Sugar, or fat, or Sugar, or fat, or

carbohydrates maybecarbohydrates maybe• Gluten-free and Gluten-free and

casein-free diet nice casein-free diet nice solution??solution??

• Vitamin B6 taken with Vitamin B6 taken with magnesium to cure???magnesium to cure???

• Secretin, a cure???Secretin, a cure???

Some theories on the cause Some theories on the cause of AUTISM . . . 3. of AUTISM . . . 3.

vaccinationsvaccinations

• THIMEROSAL, a mercury-THIMEROSAL, a mercury-based preservative used based preservative used in the measles-mumps-in the measles-mumps-rubella (MMR) vaccinerubella (MMR) vaccine

• Not used in US vaccines Not used in US vaccines anymore.anymore.

• Therapies such as Therapies such as Lauana Lei (magnetic Lauana Lei (magnetic clay bath) therapy to clay bath) therapy to extract mercury from extract mercury from bodybody

Some theories on the Some theories on the cause of AUTISM . . . 4. cause of AUTISM . . . 4.

Brain . . .Brain . . .• Abnormal brain Abnormal brain

development development beginning in the beginning in the infant’s first months.infant’s first months.

• Caused by genetic Caused by genetic defects in brain defects in brain growth factorsgrowth factors

• Sudden, rapid head Sudden, rapid head growth – early growth – early warning signalwarning signal

• Not verified nor Not verified nor discredited to datediscredited to date

Some theories on the cause of Some theories on the cause of AUTISM . . . 5. Genetic AUTISM . . . 5. Genetic

PredispositionPredisposition

• Researchers have discovered Researchers have discovered a genetic predisposition to a genetic predisposition to ASD, which “interacts with an ASD, which “interacts with an as-yet-unknown as-yet-unknown environmental factor or environmental factor or factors and causes alterations factors and causes alterations to the immune system, the to the immune system, the sensory nervous system, the sensory nervous system, the brain, and often the brain, and often the gastrointestinal tract as well.” gastrointestinal tract as well.”

• (Cure Autism Now)(Cure Autism Now)

Some theories on the cause of Some theories on the cause of AUTISM . . . 6. brain AUTISM . . . 6. brain

inflammationinflammation• Recent research at Recent research at

Johns Hopkins School of Johns Hopkins School of Medicine suggests that Medicine suggests that autism may be related autism may be related to brain inflammation, to brain inflammation, and further, the brain’s and further, the brain’s immune system may be immune system may be triggered by factors triggered by factors “possibly including birth “possibly including birth complications, diet, complications, diet, toxins, or infections.”toxins, or infections.”

Some theories on the cause Some theories on the cause of AUTISM . . . 7. Nitric Oxideof AUTISM . . . 7. Nitric Oxide

• A BBC report on this A BBC report on this study (previous page) study (previous page) adds that “another adds that “another study found raised study found raised levels of nitric oxide in levels of nitric oxide in the plasma of children the plasma of children with autism. The with autism. The chemical plays a role in chemical plays a role in the immune response, the immune response, and is known to affect and is known to affect neurodevelopmental neurodevelopmental processes.processes.

Medications sometimes Medications sometimes used for ASDused for ASD

• Selective serotonin Selective serotonin reuptake inhibitorsreuptake inhibitors (prozac, (prozac, fluoxetine, etc.) (anxiety fluoxetine, etc.) (anxiety and depression)and depression)

• Antipsychotic medicationsAntipsychotic medications (haloperidol, thioridazine, (haloperidol, thioridazine, etc.) (behavioral problems)etc.) (behavioral problems)

• AnticonvulsantsAnticonvulsants (Tegretol, (Tegretol, Lamictal, etc.) (seizures)Lamictal, etc.) (seizures)

• Stimulant medicationsStimulant medications (Ritalin, etc.) (inattention (Ritalin, etc.) (inattention and hyperactivity)and hyperactivity)

Other treatments . . .Other treatments . . .• Early interventionEarly intervention• Special EducationSpecial Education• DietsDiets• Neurotransmitter Neurotransmitter

manipulation (serotonin, manipulation (serotonin, dopamine, epinephrine)dopamine, epinephrine)

• Clay BathsClay Baths• Facilitated Facilitated

Communication (next) Communication (next) (and then after that)(and then after that)

• Applied Behavior AnalysisApplied Behavior Analysis

FACILITATED FACILITATED COMMUNICATIONCOMMUNICATION

• Started in Australia in Started in Australia in 1970s1970s

• Facilitator supports Facilitator supports client’s hand, wrist, or client’s hand, wrist, or armarm

• Client touches Client touches alphabet blocks to alphabet blocks to spell out wordsspell out words

• Much controversyMuch controversy• Class activityClass activity

Applied Behavior Applied Behavior AnalysisAnalysis

• Developed by Ivar Developed by Ivar LovaasLovaas

• Calls for “intensive, Calls for “intensive, one-on-one child-one-on-one child-teacher interaction teacher interaction for 40 hours a week”for 40 hours a week”

• Goal to reinforce Goal to reinforce desirable behaviors desirable behaviors and reduce and reduce undesirable onesundesirable ones

Other hopeful Other hopeful interventionsinterventions

• Developmental/Individual Developmental/Individual Difference ModelDifference Model – finding where – finding where the child differed from the norm the child differed from the norm and getting him/her back on and getting him/her back on tracktrack

• Dr. Stanley Greenspan Dr. Stanley Greenspan developed developed “Floor Time”“Floor Time” – – purposeful intervention purposeful intervention enmeshed in playenmeshed in play

• Social Story –Social Story – ways that children ways that children can learn the social cues that can learn the social cues that they are missing taught to the they are missing taught to the child in a storychild in a story

And more . . .And more . . .• Therapeutic Horseback Riding Therapeutic Horseback Riding

(Hippotherapy) –(Hippotherapy) – promotes sensory promotes sensory integration, coordination, balance, and integration, coordination, balance, and communicationcommunication

• Auditory Intervention Training Auditory Intervention Training Strategies –Strategies – Alfred Tomatis developed Alfred Tomatis developed an electronic ear that modulates sound an electronic ear that modulates sound for the child with autism.for the child with autism.

• Music Therapy –Music Therapy – physical and emotional physical and emotional outletsoutlets

• Touch –Touch – deep massages, or “Squeeze deep massages, or “Squeeze Machine” (invented by Temple Grandin) Machine” (invented by Temple Grandin) which applies constant deep pressure which applies constant deep pressure to the bodyto the body

AND FINALLY . . . AND FINALLY . . .

• Recreation Therapy – Recreation Therapy – Relaxation and enjoyment; Relaxation and enjoyment; leisure activities; can include leisure activities; can include direct instruction, peer direct instruction, peer mentors, etc.mentors, etc.

• Gluten-free, casein-free dietsGluten-free, casein-free diets• Anti-yeast dietsAnti-yeast diets• Mercury detoxificationMercury detoxification• Vitamin B6Vitamin B6• SecretinSecretin

Sources of InformationSources of Information

• Autism: A Project Life Book 2005, funded by Autism: A Project Life Book 2005, funded by Missouri Department of Mental HealthMissouri Department of Mental Health

• http://www.nas.org.ukhttp://www.nas.org.uk• http://www.athealth.comhttp://www.athealth.com• http://home.coqui.nethttp://home.coqui.net• http://www.specialfamilies.comhttp://www.specialfamilies.com• http://www.nytimes.comhttp://www.nytimes.com• ““Human Exceptionality: School, Community, Human Exceptionality: School, Community,

and Family” by M. L. Hardman, C. J. Drew, & M. and Family” by M. L. Hardman, C. J. Drew, & M. W. Egan (2006)W. Egan (2006)

• ““The Exceptional Child: Inclusion in Early The Exceptional Child: Inclusion in Early Childhood Education” by K. E. Allen and G. E. Childhood Education” by K. E. Allen and G. E. Cowdery (2005)Cowdery (2005)