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UNDERSTAND THE AUTISM
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DEFINITION
ITS A developmental disability significantly affecting
Verbal
nonverbal communication
social interaction
generally evident before age three
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CHARACTERSTICS
engagement in repetitive activities
stereotyped movements
resistance to environmental change
change in daily routines
unusual responses to sensory experiences
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Sensory issues
Over or under-sensitivity to noises,lighting, odors, tastes, textures, pain
Sensory over-selectivity
Failure to respond
Hidden senses
vestibular(movement and balance)
proprioceptive (feedback on how much
force or pressure to apply when picking
up something or holding an item)
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Cognitive issues
Difficulty drawing conclusions Difficulty with incidental learning
Often excellent rote memory
Slower at retrieving information Slowerprocessing speed
Problems with working memory
Trouble predicting outcomes (e.g.,peoples reactions)
Often do not see cause-effect
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Cognitive issues continue
Problems with executive function Issues with shift: moving freely from one
activity/situation to another, transitions, flexible
problem solving
Issues with initiation; cant begin tasks
Issues with planning, organizing, sequencing,
setting goals/objectives
Issues with seeing big picture or main idea Issues with evaluating activity; pace, completion,
Issues with modulating emotional response
Issues with controlling impulses
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History of Autismo Term autism originally used by Bleuler (1911)
o To describe withdrawal from social relations into a rich fantasy life seen in
individuals with schizophrenia
o Derived from the Greek autos (self) and ismos (condition)
o Leo Kanner 1943
o Observed 11 children
o Inattention to outside world: extreme autistic aloneness
o Similar patterns of behavior in 3 main areas:
1. Abnormal language development and use
2. Social skills deficits and excesses
3. Insistence on sameness
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History of Autism
oPsychiatrist Hans Asperger (1944) - describes little professor
syndrome
o Eisenberg and Kanner (1956)o Added autism onset prior to age 2
o Further refined definition of autism
o Creak (1961)
o Developed 9 main characteristicso Believed they described childhood schizophrenia
o Incorporated into many descriptions of autism and commonly used
autism assessment instruments today
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History of Autismo Rutter (1968)
o Said the term autism led to confusion!
o Argued autism was different than schizophrenia
o Higher M:F ratio
o Absence of delusions & hallucinations
o Stable course (not relapse/marked improvement)
o Further defined characteristics (for science, research)
o National Society for Autistic Children
o One of the 1st & most influential parent groups for children with autism in U.S.
o Wrote separate criteria (for public awareness, funding)
o Added disturbances in response to sensory stimuli & atypical development
o Did not include insistence on sameness
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Myths
Individuals with autism never makeeye contact
Autism is a mental illness.
Individuals with autism do not speak.Autism can be outgrown.
Individuals with autism cannot learn
autistic children are retarded. Autismcan be completely cured.
Autistics have no sense of humour.
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Myths
inside a child with autism is a genius. Individuals with autism are very
manipulative.
Individuals with autism cant smile; cannot show affection
do not want friends
do not learnAutism is caused by poor parenting
and a lack of initial bonding.
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Prevalence of Autism
2-6 cases per 1,000 growing at a rate of 10-17 percent per year
diagnostic boundaries have changed inclusion of spectrum Increasing recognition of comorbidity (e.g.
Downs, Tourette syndrome, cerebral palsy) Improvements in case-finding methods Populations sampled Increased public awareness Introduction of the MMR vaccine
boy:girl- 4:1(more severe in girls) Usually identified before 30 months
No racial or socioeconomic differences
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CAUSES
Monozygotic vs. dizygotic twin studieshave shown that if 1 identical twin has
autism, the chance that the other twin
has autism is 10 times higher than thatof fraternal twins
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Neurotransmitters
Serotonin Some studies have found higher levels
in children with ASD
Opioids Display properties similar to morphine Administration can result in stereotypy,
insensitivity to pain, reduced
socialization Some studies have found higher levels
in children with ASD
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CAUSES
Other Theories: Heavy metals
Pollutants
Toxins
Vaccines
Chemicals
Pesticides
Gastrointestinal issues *none of these have been empirically
proven to cause autism*
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high risk parameters
Siblings of children with ASD: 10 x increased risk Premature Infants
Comorbid Genetic Syndromes: e.g. Fragile Xsyndrome, Tuberous Sclerosis
Prenatal Exposures e.g. Valproic acid
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Early Development
communication andrelating to other people
followed by social-
emotional development ofbaby is key to form strong
relationships and
continued learning which
starts from the birth itself
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By the end of 3 months
Begin to develop a socialsmile
Enjoy playing with otherpeople and may cry when
playing stops Become more expressive
and communicate morewith face and body
Imitate some movementsand facial expressions
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By the end of 7 months
Smile back at another person Respond to sound with sounds
Enjoy social play
By the end of 12 months Use simple gestures (pointing,
showing, waving bye,) Imitate actions in their play
Respond when told no
Start babbling mama, dada, baba
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By the end of 18 months
Do simple pretend play
Point to interesting objects
Use several single words unprompted
By the end of 2 years(24 months)
Use 2- to 4-word phrases
Follow simple instructions
Become more interested in other children
Point to object or picture when named
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Role of physician/ Counselor
Early recognition based on Knowledge of signs and symptoms
Developmental surveillance and
screening
Guiding families to diagnosticresources and intervention services
Conducting a medical evaluation Providing ongoing health care
Supporting and educating families
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DIAGNOSIS
Major areas
Communication
Socialization
Behavior
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Communication
Delay in, or complete lack of, verbalcommunication
Difficulty in initiating or sustaining
conversations Stereotyped or idiosyncratic use of
language (echolalia, jargon)
Inability to engage in spontaneous,make- believe, or imitative play at theappropriate developmental level
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Socialization
Difficulty developing peer relationshipsappropriate to developmental level
Impaired use of nonverbal behaviors
(e.g., eye contact, facial expressions,and gestures)
Lack of spontaneous seeking to shareenjoyment, interests, or achievements
with other people (joint attention) Lack of social or emotional reciprocity
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Behavior
Preoccupation with an activity orinterest that is abnormal either in
intensity or focus
Inflexible adherence to nonfunctionalroutines or rituals
Repetitive or stereotyped movements
(e.g., hand flapping) Persistent preoccupation with parts of
objects
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Treatment
Goals
Minimize core features and associated deficits
Maximize functional independence
Alleviate family stress
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Speech and language therapy
Redesign of education pattern
Educate the parents/ guardian/
siblings
Conduct applied behavioral analysis
(ABA) and treat according to the score
ABA : It is the repetitive use of positivereinforcement to teach specific skills and
decrease inappropriate behaviors.
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Son-Rise Program encourages providers and parents to teach with
enthusiasm and to employ a non-judgementalattitude.
floor time treatment Floor Time is simply the idea that a childs
communication skills can be improved bybuilding on his/her strengths while playingtogether on the floor.
Pivotal Response Treatment
to teach language, decrease inappropriatebehaviors, and increase social skills andacademics.
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Symptoms/ Disorders Freq TreatmentsAttentional, impulsivity,hyperactivity
59% Behavioral interventionPsychopharmacotherapy stimulants, atomoxetine,
alpha agonists, anti-anxiety
Anxiety 43-84% Behavioral treatment relaxation, cognitive
Psychopharmacotherapy SSRI, alpha agonist
Depression 2-30% Psychotherapy
Medication anti-depressants
Obsessive compulsive
symptoms
37% Behavioral treatment, supportive counseling;
Medication SSRI, others
Disruptive, irritable or
aggressive behavior
8-32% Behavioral intervention
Medication atypical neuroleptics (risperidone,
arapiprazole, others)
Self-injurious behavior 34% Behavioral intervention
Medication (e.g., naltrexone, risperidone, others)
Tics 8-10% Medications; Alpha agonist (clonidine, guanfacine),
others
Sleep disruption 52-73% Sleep diary; sleep hygiene; behavioral supports;
investigate possible medical comorbidity/ies as
cause(s)
Psychopharmacology
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