AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS LECTURE OUTLINE History and background

1. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • LECTURE OUTLINE • History and background • Diagnostic features • Other pervasive developmental disorders • Etiology • Treatment

2. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • History and background • Originally called Kanner’s (1943) syndrome • Very low prevalence rates – Szatmari & Mahoney (1993) estimate < .1% in Canada • But highly dysfunctional and disabling condition • More common in boys than girls (4:1)

3. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • Diagnostic features • Social development • extreme autistic aloneness, avoid eye contact, lack of social interaction • non-responsive to social envirnoment, more interested in mechanical objects • odd behaviours – rhythmic rocking, preservation of sameness, non-compliance

4. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • Diagnostic features • Language acquisition • 50% mute • lack of meaningful communication • echolailia • pronoun reversal

5. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • Diagnostic features • Attention, perception, cognition • stimulus overselectivity • low IQ • savants • lack of independent functioning

6. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • Related disorders • Asperger disorder • Rett syndrome • Child disintegrative disorder

7. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • Etiology • Psychogenic – Bruno Bettelheim (1967), The empty fortress – “refrigerator mother” • Biological • neurobiological factors – high rates of seizures, prenatal infections and birth complications • brain impairment – several areas implicated, not just a single area

8. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • Etiology • genetics – Folstein & Rutter twin study (1978) – for cognitive impairment, 36% concordance rate for DZ twins, 82% concordance rate for MZ twins; for autism, 0% concordance rate for DZ twins, 36% concordance rate for MZ twins

9. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • Treatment • biomedical • psychodynamic • intensive behavioural treatment

10. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • Treatment – Lovaas program • original work in the 1960s at UCLA with children who had been institutionalized • used shaping, positive reinforcement, and punishment • many gains in social and language skills • but once returned to hospital, children regressed

11. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • Treatment – Lovaas program • 1979-84 – work with very young autistic children; treatment more intensive for longer periods of time; parent training component • More enduring positive outcomes than in original study

12. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • Treatment – Lovaas program • 3 groups • Intensive treatment (n=19) - > 40 hours per week of 1:1 treatment • Minimal treatment (n=19) - < 10 hours per week of 1:1 treatment • Control group (n=21) – referred to other services available to autistic children in the community

13. Outcomes of Lovaas (1987) program

14. Outcomes of Lovaas (1987) program

15. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • Limitations of Lovaas research • small sample sizes • no external evaluations, need for replication (these are in progress) • variability in response to treatment

16. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • SUMMARY • Autism is a very rare, but a very disabling disorder of childhood • Biological factors are involved, but no one single factor appears to be the causal agent

17. AUTISM AND PERVASIVE DEVELOPMENTAL DISORDERS • SUMMARY • In spite of biological basis, there are encouraging findings from studies of intensive behavioural intervention for children with this disorder • Unfortunately, these treatments are not widely available