Austism Spectrum Disorders

Molly Haban, Nehal Kothari , Erin Enright, Liz Hurley

Epidemiology

What is Autism?

• A severe behavioral disorder that develops in first 3 years of life

• Third most common DD in the US: approx 1 in every 166 births, 4x more prominent in boys

• Treatments may begin as early as 18 months of age

What is Autism?

• Referred to as a “spectrum disorder” b/c people w/ autism can have very different features or symptoms– Communication: verbal & non-verbal: use single words,

repeat words or phrases, lack of speech, poor eye contact– Social Interactions: difficulty sharing emotions &

understanding how others think/feel, difficulty holding conversation and interacting with others

• Routines or Repetitive Behaviors: repeating words or actions over and over, obsessively following routines or schedules, playing with toys in a repetitive manner, etc

What is Autism?

• Fastest-growing DD• $90 billion annual cost• 90% of costs are in adult services• Cost of lifelong care can be reduced by 2/3 with early

diagnosis and prevention• In 10 years the annual cost will be $200-400 billion• Growth during 1990’s:

– US Population increase: 13%– Disabilities increase: 16%– Autism increase: 172%

Etiology

What Causes Autism?

• Current evidence suggests that as many as 12 or more genes on different chromosomes may be involved in autism to different degrees

• Genes may make a person more susceptible, cause specific symptoms or determine how severe the symptoms are, or might add to the symptoms of autism

What Causes Autism?

• Genes/Chromosomes likely involved:– Chromosome 2– Chromosome 7– Chromosome 13– Chromosome 15– Chromosome 16– Chromosome 17– The X Chromosome– HOXA1– HOXD1– Gamma-amino-butyric acid (GABA) pathway genes

What Causes Autism?

• 24.4% of Autism cases are related to other genetic medical disorders, including: Fragile X Syndrome, Tuberous Sclerosis, PKU and Rett Syndrome

• Also linked to non-genetic infectious diseases: congenital rubella, acute encephalopathy, cytomegalovirus

Diagnostic Criteria

DSM IV CRITERIA

for

AUTISTIC DISORDER

Facts or Myth?• Autism spectrum disorders are not increasing in

incidence. They are just being better diagnosed, and diagnosed earlier so the numbers are increasing.

• Children and adults with autism spectrum disorders do not interact very much. They do not have good eye contact. They do not speak well. They are not very bright

• All people with an autism spectrum disorder have “savant skills”, like Dustin Hoffman's character in “Rain Man”.

• 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 non verbal 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. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by lack of showing, bringing, or pointing out objects of interest)

d. Lack of social or emotional reciprocity

• (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.

• (3) Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two 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 inflexible adherence to specific, nonfunctional routines or rituals

c. stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting or complex whole body movements)

d. persistent preoccupation with parts of objects.

• B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age three years:

1. Social interaction

2. Language as used in social communication or

3. Symbolic or imaginative play

C. Not better accounted for by Rett’s disorder or childhood disintegrative disorder.

Specialized Services

Fact or Myth?

• Autism is a permanent disability and it cannot be cured by any known procedure

• Children and adults with an ASD cannot learn social skills.

• Children and adults with autism spectrum disorders are very similar to one another.

Purpose of Intervention

• While there is no cure for autism, there are treatment and education approaches that may reduce some of the challenges associated with the disability. Intervention may help to lessen disruptive behaviors, and education can teach self-help skills that allow for greater independence.

Persons with Autism are Individuals• Just as there is no one symptom or

behavior that identifies autistic children, there is no single treatment.

• Children can learn to function within the confines of their disability, but treatment must be tailored to the child's individual behaviors and needs.

Treatment Approaches

• Behavioral Modification and Behavior Therapy

• Additional Therapies

• Other Treatment Approaches

Behavioral Modification and Behavior Therapy• According to the Graziano text, the most widely used

and successful teaching methods are those known as intensive behavioral intervention (IBI)– “We believe that behavior modification carried out in

systematic, highly individualized, daily programming is the best overall approach now available to persons with autism”

• Any treatment program for persons with Autism should include some form of behavior modification

Additional Treatments/Therapies• Speech therapy

– Help in developing communication skills• This includes alternative forms of communication (sign

language and the use of keyboards)

• OT and PT– Helpful in addressing specific needs for daily living

• Example need for PT:• Rinehart (2006) - Overall, the results indicate that HFA is

more consistently associated with impaired preparation/initiation of movement compared to AD.

Additional Treatments/Therapies

• Art and music therapy– May be effective in increasing communication

skills, developing social interaction, and providing a sense of accomplishment.

• Biomedical & Dietary Approaches – Medications – Vitamins & Minerals – Dietary Interventions – Secretin

Caution!

• Some treatment approaches have little or no scientific evidence supporting there use such as Facilitated Communication (FC) and Dolphin therapy– Some autistic children may show improvements

with age, and such improvement might be mistaken as the results of a particular treatment (Howlin 1997)

Caution!

• Facilitated Communication Example– Box 11.2 in Graziano text– Late 80’s brought to US and became the next big thing– Facilitators would help children with Autism “communicate”– Idea was that it was revealing the “real person” who had been

locked inside– Controlled research was done and found clear evidence that

the facilitators not the autistic students were producing the messages

• Problem: many parents had false hopes that led to greater disappointment in the end; it also may have delayed or prevented more productive lines of inquiry and treatment

• Validates the need for evidence based interventions

Treatment Summary: Key Points• Remember: Persons with Autistic disorders are

individuals and different treatments will work for different children

• Interventions should:– Involve the parents or family– Include several of the autistic dimensions– Be highly structured

• For persons with autism, life is smoothed when they are able to predict what is coming next in their daily program

– Be re-evaluated and progressed/modified when appropriate

Resources

Fact or Myth?

• OCALI is a program that receives federal funding to serve people with autism and rare disabilities.

• Special ed opportunities are extremely limited for students with autism in Columbus.

• Ohio is the first state in the U.S. to develop a state-wide scholarship program specifically for students with autism.

OCALI: OH Center for Autism and Low Incidence• www.ocali.org• Federally funded program under OH Dept. of

Ed, Office for Exceptional Children• Designed for parents and educators• Information clearinghouse – provides resource

collection, responds to individual questions, monitors changes in policies, services, etc.

• Consulting service

ASA: Autism Society of America• www.autism-society.org• National organization; Central OH chapter in

Columbus• Goal to increase public awareness through

info., education, research support, advocacy for programs and services r/t autism

• Value parents’ choice• Great resource locator on website!!!

OLRS: OH Legal Rights Services

• http://olrs.ohio.gov• State agency with mission to protect and

guarantee human, civil, and legal rights of Ohioans with disabilities

• Programs address rights related to Social Security benefits, assistive technology, voting, crime, access to services, etc.

• Serves adults and children with various disabilities

Dungarvin• www.dungarvin.com• National organization; serves Franklin,

Montgomery, and Delaware counties• For-profit corporation that provides residential

services and supports to individuals with DD under Medicaid Home & Community Based Waiver

• Day & respite services, case mgt., supported employment, certified independent living, Help Me Grow, foster care, in home supports

CCDE: Childrens Center for Developmental Enrichment

• www.ccde.org• nonprofit corporation founded by

parents of individuals with autism• parent support groups• info sessions that feature med & ed

professionals• Sibshops• Services of a psychiatric CNS

Oakstone Academy of Columbus• www.ccde.org/oakstone.html

• Chartered private school through CCDE

• Preschool through middle school

• Designed for students with autism

• Curriculum guided by ABA concepts

Autism Scholarship Program• http://olrs.ohio.gov/ASP/olrs_AutismScholars

hip.asp• Pilot program in Ohio, developed by Rep. Jon

Peterson in 2003• Allows students with autism and PDD-NOS to

attend non-public or alternative public special education program

• Scholarships up to $20,000• Must already have an IEP

Video Clip

• An incredible memorization talent...

Questions?