Autism & Asperger’s

1. Autism &Asperger’s Abbie Solish PhD Candidate Clinical-Developmental Area York University

2. Pervasive Developmental Disorders (PDD) Childhood Disintegrative Disorder Autistic Disorder PDD-NOS Rett’s Disorder Asperger’s Disorder

3. Autistic Disorder (DSM-IV) (1) Qualitative Impairment in Reciprocal Social Interaction: a) impaired nonverbals b) poor peer relationships c) lack of spontaneous social sharing d) lack of social/emotional reciprocity (must have 2 or more of 4)

4. Autistic Disorder (DSM-IV) (2) Qualitative Impairment in Communication: a) delayed/absent speech b) impaired conversational skills c) stereotyped, repetitive language d) lack of pretend and social play (must have 1 or more of 4)

5. Autistic Disorder (DSM-IV) (3) Restricted, Repetitive, & Stereotyped Patterns of Behaviour, Interests, & Activities: a) preoccupations, narrow interests b) adherence to routine, ritual c) stereotyped behaviour d) preoccupation with parts of objects (must have 1 or more of 4)

6. Ben Loves Trains Ben is 2.5 and he loves trains. He is content to play with them alone for hours. Yet he doesn’t seem to really understand that they are trains. He doesn’t pretend to make them go on the track or have crashes or imagine what the cars are carrying or talk, as he plays alone. He just lines them up in the same way every time. He gets very upset if anyone rearranges his trains. Sometimes he carries a train around with him and rubs it against his chin or waves it in front of his eyes. He never brings a train to show his father, never points to the trains to show his sister. In fact, he completely ignores his sister. Ben doesn’t talk at all, rarely looks at other people and rarely smiles…

7. Early Behaviours in Autism:What these children often do • Avoid eye contact • Avoid others, appear aloof • Use toys in repetitive, non-functional ways • Focus on parts of objects • Tantrums/problem behaviours • Odd speech (if any) • Instrumental communication • Autistic leading • Stereotypies (e.g., flapping hands) • Know familiar people

8. Early Behaviours in Autism:What these children often don’t do • Make eye contact • Imitate • Pretend play • Joint attention gestures (e.g., eye gaze, pointing) • Social interest and social play • Use language to comment • Use language for social purposes • Theory of mind

9. Early ‘Red Flags’ • no babbling 12 months • no pointing, other gestures 12 months • no single words 16 months • no spontaneous 2-word phrases 24 months • any loss of language or other skills at any age • With younger children the absence of typical behaviour is more diagnostic than presence of atypical behaviour

10. Early Diagnosis • If ‘red flags’ are present, specific autism diagnostic tools are used • A diagnosis should incorporate information from various sources • A reliable & valid diagnosis can be made by age 2 by an expert clinician • Likely trend towards overdiagnosis in young delayed children and trend towards underdiagnosis in high-functioning children

11. Prevalence (best estimates) • Autistic Disorder  10 per 10,000 • PDD-NOS  15 per 10,000 • Asperger’s  2.5 per 10,000 • Total  27.5 per 10,000 (1 per ~350) •  Ratio  4:1 Males:Females

12. Is Autism Increasing? • It depends… • Prevalence vs. Incidence • Prevalence = % of people in the population who have the disorder • Definitely increasing • Incidence = # of new cases per unit of time • Debatable, no good evidence of increase

13. Why does is seem like autism is “increasing”? • The diagnostic criteria have broadened and changed • Much better now at early diagnosis • Low functioning children can now get a diagnosis of autism rather than just MR • At the high end of the spectrum there is more recognition of the broader phenotype

14. Who has autism? • No relationship to SES • No relationship to immigrant status • No relationship to race or ethnicity • No environmental causes/clusters • Some evidence of genetic concordance

15. What “causes” autism? • A specific cause has not been yet been identified • Current investigations specific to autism include: • birth and pregnancy problems • problems in specific areas of brain • brain chemicals (neurotransmitters) • brain infections • genetics • One single cause cannot account for everything/all subtypes of PDD • We do know that it is NOT parents

16. Is there a “cure”?...New & Alternative Treatments • Auditory Training • Sensory Integration • Vitamins/Food Supplements • Special Diets/Food Allergies, Sensitivities • Physical Exercise • Holding Therapy • Deep Pressure • Facilitated Communication • Miller Method • Irlen Lenses • Patterning • Gentle Teaching • Swimming with Dolphins • Secretin • Centrifugal Therapy • …

17. New & Alternative Treatments • The problem is that most of these treatments are not supported by any research • Many parents believe in “miracle” or “breakthrough” “cures” • Gives them hope • Feel less helpless • Danger in not accepting the child as he/she is • Expensive

18. Intensive Behavioural Intervention(IBI) • “Intensive” (often 20-40 hrs/wk for 1-2 yrs.) • Begin early (usually before 4) • Schedule is highly structured and predictable • Program is individualized • Specific teaching methods vary • Include complex variety of techniques to promote independence and generalization

19. 2 Dimensions of Severity Autistic Symptom Severity Asperger’s Autistic PDD-NOS Disorder Disorder Severity of Intellectual Disability Profound Severe Moderate Mild Borderline Average Superior

20. Carolyn Just Wants to Be Friends Carolyn is 12 and is great at puzzles. She can do them just as fast whether they are picture side up or upside down! She struggles with her school work, especially language arts and social studies, but is pretty good at spelling and math and has an excellent memory. She was in special education classes when she was younger, but is now in a regular class. She seems very friendly and talkative, though a bit immature. She goes up and asks questions of anyone she comes in contact with, even if they’re not interested in talking to her. She doesn’t know how to relate to other kids very well but really wants to be friends. She is enrolled in a social skills group at a local treatment agency. Her mother worries about what is in store for Carolyn as a teenager and adult…

21. Asperger’s Disorder(DSM-IV) A. Qualitative Impairment in Reciprocal Social Interaction: a) impaired nonverbals b) poor peer relationships c) lack of spontaneous social sharing d) lack of social/emotional reciprocity (must have 2 or more of 4)

22. Asperger’s Disorder(DSM-IV) B. Restricted, Repetitive, and Stereotyped Patterns of Behaviour, Interests, and Activities: a) preoccupations, narrow interests b) adherence to routine, ritual c) stereotyped behaviour d) preoccupation with parts of objects (must have 1 or more of 4 criteria)

23. Asperger’s Disorder(DSM-IV) C. Clinically significant impairment in social, occupational functioning D. No clinically significant language delay E. No clinically significant cognitive delay, adaptive behaviour

24. Prevalence • Prevalence ranges: • 3-4 in every 1000 children develop the full clinical picture of AS • 2.5 per 10,000 • Why is there such a range? • No consistent diagnostic criteria for AS • 6:1 Male to Female ratio • Actual ratio is believed to be closerto 4:1

25. Other difficulties associated with Asperger’s • IQ profile • Communication problems affecting speech and language • Language “oddities”: • Hyperlexia • Literal use and understanding of language • Pragmatic difficulties • Flat prosody • Perceptual problems • Motor control problems

26. Comorbidity • ADHD • Tics and Tourette Syndrome • Anxiety • Social anxiety • OCD • Conduct disorder • Eating disorders • Mood Disorders • Depression (most common secondary diagnosis) • Bipolar • Suicidal ideation • Alcohol and Drug abuse • Schizophrenia & isolated psychotic episodes

27. Interventions for Asperger’s • Not one specific empirically validated treatment (like IBI for Autism) • Social skill groups • School interventions • Medications • often used to treat comorbid conditions • have to watch for atypical reactions to the drugs • e.g., SSRIs, Neuroleptic, Stimulants, Anti-epileptic drugs, Lithium

28. Summary • Autism and Asperger’s are two of the Pervasive Developmental Disorders • Children with Autism must show impairments in social and communication abilities as well as have behavioural concerns to receive a diagnosis • Children with Asperger’s must show impairments in their social abilities and specific behavioural concerns, but do not show language impairments like children with Autism • The prevalence of Autism/Asperger’s is increasing, although perhaps not the incidence • The “cause” of Autism/Asperger’s is still unknown • There is currently no “cure” for Autism or for Asperger’s • IBI is the current intervention of choice for children with Autism