AUTISTIC SPECTRUM DISORDER: an overview

1. AUTISTIC SPECTRUM DISORDER: an overview Carolynne Pinder Nurse Practitioner Child Development 2012. Adapted Pam Schultz February 2013

3. FIGURES RE: AUTISM • In 2001 60 out of every 10,000 children under 8 yrs have ASD. • Same year 10- 30 out of every 10,000 children under 8 yrs have Autism using a narrower definition. • 2004 1/3 of children with ASD aged 5 – 16 yrs, had another clinically recognised mental health condition.

4. 97% of ASD children 5 – 16 yrs have Special Educational Needs. ( 16% of the total population have Special Educational Needs).

5. Data from the Family Fund Statistics indicates that there are increasing numbers of disabled children. Much of the increase is due to an increase in the number of children with Autistic Spectrum Disorders.

6. 1978 4 in 10,000 ASD Michael Rutter • 1983 1 -2 in 1,000 ASD Lorna Wing • 1993 1 in 330 Asperger’s Christopher Gillberg • 2001 1 in 166 ASD Cambridge study • 2006 1 in 100 ASD Gillian Baird Baron –Cohen (2008)

7. The three main areas of difficulty which all people with autism share are sometimes known as the 'triad of impairments'. They are: • difficulty with social communication • difficulty with social interaction • difficulty with social imagination. NAS 2009

8. Autism is ONE of the pervasive developmental disorders (PDD) Other PDDs include: • Asperger syndrome • PDD-NOS Pervasive developmental disorder not otherwise specified • Rett syndrome • Childhood disintegrative disorder

10. In 1943 Dr. Leo Kanner of Johns Hopkins University described autism for the first time. He based his discovery from 11 children he observed between 1938 and 1943. He studied children who had had withdrawal from human contact as early as age 1.

12. 1944 • Die 'autistischen psychopathen' im kindesalter (Autistic psychopathy of childhood)Hans Asperger www.neurodiversity.com 2009

14. Difficulty with social communication • facial expressions or tone of voice • jokes and sarcasm • common phrases and sayings; an example might be the phrase 'It's cool', which people often say when they think that something is good, but strictly speaking, means that it's a bit cold.

15. Some people with autism may not speak, or have fairly limited speech. • They may use alternative means of communication themselves, such as sign language or visual symbols. • Often repeat what the other person has just said - echolalia

16. Difficulty with social interaction • People with autism often have difficulty recognising or understanding other people's emotions and feelings, and expressing their own, which can make it more difficult for them to fit in socially.

18. not understand the unwritten social rules which most of us pick up without thinking: they may stand too close to another person for example, or start an inappropriate subject of conversation • appear to be insensitive because they have not recognised how someone else is feeling

19. prefer to spend time alone rather than seeking out the company of other people • not seek comfort from other people • appear to behave 'strangely' or inappropriately, as it is not always easy for them to express feelings, emotions or needs.

20. Difficulties with social interaction can mean that people with autism find it hard to form friendships: some may want to interact with other people and make friends, but may be unsure how to go about this

22. Difficulty with social imagination Difficulties with social imagination mean that people with autism find it hard to: • understand and interpret other people's thoughts, feelings and actions • predict what will happen next, or what could happen next • understand the concept of danger, for example that running on to a busy road poses a threat to them

23. engage in imaginative play and activities: children with autism may enjoy some imaginative play but prefer to act out the same scenes each time • prepare for change and plan for the future • cope in new or unfamiliar situations.

24. Other related characteristics • Love of routines • Ritualistic/repetitive behaviours • Sensory sensitivity • Special interests • Learning disabilities

26. Ritualistic/Repetitive behaviours • Flicking fingers, objects, pieces of string, small items • Watching things that spin • Tapping and scratching on surfaces • Inspecting- walking along tracing lines and angles • Feeling special textures • rocking

27. Tapping or scratching parts of their body • Repetitive head banging or self injury • Teeth grinding • Repetitive screaming, grunting or other noises

28. Scientists believe that not seeing a response after calling by name a one year old child is an easy at-home test that might raise a possibility of autism Archives of Pediatrics & Adolescent Medicine. (Aparna. 2007)

29. Asperger’s syndrome

36. Famous Aspergers people • Gary Numan • Satoshi Tajiri – creator and designer of Pokemon • Jane Austin • Beethoven • Alexander Graham-Bell • Lewis Carroll • Charles Darwin • Thomas eddison • Albert Einstein • Henry Ford • Adolf Hitler

37. …..contd • James Joyce • Michaelangelo • Isaac Newton • Mozart • George Orwell • Enoch • Powell • Andy Warhol • Alan Turing – Inventor of Enigma www.autismparents.net

38. NICE Guidelines • 1.2.1 Consider the possibility of ASD when there are concerns about development or behaviour, but be aware that there may be other explanations for individual signs and symptoms. • 1.2.2 Always take parental concerns about behaviour or development seriously, even if these are not shared by others.

39. NICE Guidelines • 1.2.3 When considering the possibility of ASD and whether to refer a child or young person to the ASD team, be self-critical about your professional competence and seek advice from a colleague if in doubt about the next step.

40. What to look for:

41. Assessment by HV/SN • M-CHAT. • NICE guidelines. • Red flags for Autism. • School observation ?

42. Autism pathway • Referral received by Admin at Community Paeds • Questionnaires sent to school and home • Once questionnaires have been returned case is discussed at monthly RPM- Referrals Planning meeting.

43. Decision made: • If ASD pathway: Ed psych assessment requested, SLT will assess social speech at school observation, Paediatrician will see. • If not ASD: paediatrician may see but may not. i.e. if known LD. Signposting suggested to referrer.