Autism: The spectrum disorder

1. Autism: The spectrum disorder What is It, Symptoms, Causes and Treatment

2. Did You Know? • Autism… • now affects 1 in 88 children and 1 in 54 boys • is the fastest-growing serious developmental disability in the U.S. • costs a family $60,000 a year on average • receives less than 5% of the research funding of many less prevalent childhood diseases • Boys are nearly five times more likely than girls to have autism • There is no medical detection or cure for autism

3. What is Autism? What is Autism Spectrum Disorder? • Agroup of complex disorders of brain development • Characterized by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors • Originally recognized as distinct subtypes • Now all autism are merged under one umbrella diagnosis of ASD

4. The Umbrella of ASD All of these disorders are on the Spectrum of Autism. Asperger’s was originally considered an autistic disorder but is now a separate disorder under the spectrum.

5. Autism Spectrum Disorder Diagnosis Criteria • Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history • Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions • Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication • Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative paly or in making friends; to absence of interest in peers

6. Autism Spectrum Disorder Diagnosis Criteria • Restricted, repetitive patterns of behavior, interests, or activities, of at least two of the following: • Stereotyped or repetitive motor movements, use of objects, or speech • Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior • Highly restricted, fixated interests that are abnormal in intensity or focus • Hyper- or hyperactivity to sensory input or unusual interests in sensory aspects of the environment (i.e. apparent indifference to pain/temperature, adverse response to specific sounds or textures)

7. Autism Spectrum Disorder Diagnosis Criteria • Symptoms must be present in the early developmental period (but may not become fully apparent until social demands exceed limited capacities, or may be masked by learned strategies in later life) • Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning • These disturbances are not better explained by intellectual disability (intellectual developmental disorder).

8. Autism Spectrum Disorder Diagnosis Criteria • Severity dependent on social communication impairments and restricted repetitive patterns of behavior (Table) • Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. • Specifyif: • With or without accompanying intellectual impairment • With or without accompanying language impairment • Associated with a known medical or genetic condition or environmental factor • Associated with another neurodevelopmental, mental, or behavioral disorder • With catatonia (state of unresponsiveness to external stimuli)

9. Severity levels for Autism Spectrum Disorder A person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.

10. Severity levels for Autism Spectrum Disorder A person who speaks simple sentences, whose interaction is limited to narrow special interests, and how has markedly odd nonverbal communication.

11. Severity levels for Autism Spectrum Disorder A person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.

12. A Look at the Symptoms http://youtu.be/FuWWie1DlJY

13. Symptoms: Social Challenges • Difficulty in engaging in the give-and-take of everyday human interactions • By 8 to 10 months of age, many infants who later develop autism are showing some symptoms such as failure to respond to their names, reduced interest in people and delayed babbling. By toddlerhood, many children with autism have difficulty playing social games, don’t imitate the actions of others and prefer to play alone. They may fail to seek comfort or respond to parents' displays of anger or affection in typical ways. • Attached to their parents • The way they express this attachment can be unusual. To parents, it may seem as if their child is disconnected. • Both children and adults with autism have difficulty interpreting what others are thinking and feeling. Things like waving and smiling go without recognition. Without the ability to interpret gestures and facial expressions, the social world can seem bewildering. • Difficulty seeing things from another person's perspective • Most five year olds understand that other people have different thoughts, feelings and goals than they have. A person with autism may lack such understanding. Thiscan interfere with the ability to predict or understand another person’s actions. • Common difficulty regulating emotions • “Immature” behavior such as crying or having outbursts in inappropriate situations. • Disruptive and physically aggressive behavior

14. Symptoms: Communication Difficulties • Delayed in babbling and speaking and learning to use gestures • Significant language delays and don’t begin to speak until much laterin life • Many nonverbal or nearly nonverbal children and adults learn to use communication systems such as pictures, sign language, electronic word processors or even speech-generating devices • When language begins to develop, they may use speech in unusual ways and have difficulty combining words into meaningful sentences • They may speak only single words or repeat the same phrase over and over. Some go through a stage where they repeat what they hear verbatim. • Slight delays in language or develop precocious language and unusually large vocabularies • They may carry on monologues on a favorite subject • Inability to understand body language, tone of voice and expressions that aren’t meant to be taken literally  • May not exhibit typical body language. Facial expressions, movements and gestures may not match what they are saying. Their tone of voice does not reflect their feelings. Some use a high-pitched sing-song or a flat, robot-like voice. This can lead to frustration and inappropriate behavior (such as screaming or grabbing) on the part of the person with autism.

15. Symptoms: Repetitive Behaviors • Common repetitive behaviors include hand-flapping, rocking, jumping and twirling, arranging and rearranging objects, and repeating sounds, words, or phrases. • Sometimes the repetitive behavior is self-stimulating, such as wiggling fingers in front of the eyes. • Tendency to engage in a restricted range of activities • Some spend hours lining up toys in a specific way instead of using them for pretend play. • Some adults are preoccupied with having household or other objects in a fixed order or place. It can prove extremely upsetting if someone or something disrupts the order. • Many children and adults with autism need and demand extreme consistency in their environment and daily routine. Slight changes can be extremely stressful and lead to outbursts  • Repetitive behaviors can take the form of intense preoccupations, or obsessions. • These extreme interests are either an object’s content (fans, vacuum cleaners or toilets) or depth of knowledge (knowing and repeating astonishingly detailed information about Thomas the Tank Engine or astronomy). • Older children and adults with autism may develop tremendous interest in numbers, symbols, dates or science topics.

16. Associated Medical Conditions: Genetic Disorders • Some children with autism have an identifiable genetic condition that affects brain development. • Fragile X syndrome • Angelman syndrome • Tuberous sclerosis • Chromosome 15 duplication syndrome and other single-gene and chromosomal disorders • Single gene disorders appear to affect 15 to 20 percent of those with ASD. Some of these syndromes have characteristic features or family histories. 

17. Associated Medical Conditions: Gastrointestinal (GI)Disorder • GI distress affects up to 85 percent of children with ASD. • These conditions range in severity from a tendency for chronic constipation or diarrhea to inflammatory bowel disease. • Pain caused by GI issues can prompt behavioral changes such as increased self soothing (rocking, head banging, etc) or outbursts of aggression or self-injury. Conversely, appropriate treatment can improve behavior and quality of life.

18. Associated Medical Conditions: Seizure Disorder • Seizure disorders (such as epilepsy) occur in as many as 39 percent of those with autism. • It is more common in people with autism who also have intellectual disability than those without. • Someone with autism may experience more than one type of seizure. • Seizures associated with autism tend to start in either early childhood or adolescence.

19. Associated Medical Conditions: Sensory Processing Problems • Many persons with autism have unusual responses to sensory input. • They have difficulty processing and integrating sensory information, or stimuli, such as sights, sounds smells, tastes and/or movement. • They may experience seemingly ordinary stimuli as painful, unpleasant or confusing. • They can be hypersensitive to sounds or touch, a condition also known as sensory defensiveness. • Others are under-responsive, or hyposensitive.

20. Associated Medical Conditions: Pica and Sleep Dysfunction Disorder • Pica is a tendency to eat things that are not food. • Eating non-food items is a normal part of development between the ages of 18 and 24 months. • Some children and adults with autism and other developmental disabilities continue to eat items such as dirt, clay, chalk or paint chips. • Sleep problems are common among children and adolescents with autism and may likewise affect many adults.

21. Causes • There is no known single cause for autism, but it is generally accepted that it is caused by abnormalities in brain structure or function • Brain scans show differences in the shape and structure of the brain in children with autism versus in neurotypicalchildren • Researchers are investigating a number of theories, including the links among heredity, genetics and medical problems.

22. Control Brain vs Autistic Brain The brain of an individual with autism is larger than the brain of someone without the disorder. It also has significantly less activity and active growth.

23. Causes: Genetic • In many families, there is a pattern of autism or related disabilities • No one gene has been identified as causing autism • Researchers are searching for irregular segments of genetic code that children with autism may have inherited. • Some children are born with a susceptibility to autism, but researchers have not identified a single "trigger" that causes autism to develop • Other researchers are investigating the possibility that under certain conditions that a cluster of unstable genes may interfere with brain development resulting in autism.

24. Causes: Environmental Factors • Environmental toxins (e.g. heavy metals such as mercury) are more prevalent in our environment than in the past • Findings indicate many children with autism or at risk have a metabolic impairment that reduces their ability to rid their bodies of heavy metals and other toxins • Buildup of these toxins in the body can lead to brain and nervous system damage and developmental delays.

25. Causes: Disorder of the Limbic Brain • Richard Lathe believes the disorder is a disorder of the limbic brain • The limbic brain is very sensitive to environmental toxins • He found children with autism exert behaviors similar to people who have suffered injuries in the hippocampus and amygdala

26. Treatment • Each child or adult with autism is unique so each autism intervention plan is addressed to their specific needs • Intervention can involve behavioral treatments, medicines or both • Addressing other medical issues such as sleep disturbance, seizures and gastrointestinal (GI) distress associated with autism can improve attention, learning and related behaviors

27. Treatment • Early intensive behavioral intervention involves a child's entire family, working closely with a team of professionals • In some early intervention programs, therapists come into the home to deliver services • This can include parent training with the parent leading therapy sessions under the supervision of the therapist. • Other programs deliver therapy in a specialized center, classroom or preschool.

28. Treatment • Different interventions and supports change as a child develops and acquires social and learning skills • As children with autism enter school, they may benefit from targeted social skills training and specialized approaches to teaching • Transition services are used for adolescents that promote a successful maturation into independence and employment opportunities of adulthood • Meant for less severe forms of autism

29. Treatment Options for Toddlers and Preschool Children: Early Intensive Behavioral Intervention • The child receives structured, therapeutic activities for at least 25 hours per week • Highly trained therapists and/or teachers deliver the intervention • Therapy is guided by specific and well-defined learning objectives, and the child’s progress is regularly evaluated and recorded • Focuses on the core areas affected by autism • These are social skills, language and communication, imitation, play skills, daily living and motor skills • Provides the child with opportunities to interact with typically developing peers • The program actively engages parents in the intervention in decision making and the delivery of treatment • The therapists make clear their respect for the unique needs, values and perspectives of the child and his or her family • The program involves a multidisciplinary team that includes a physician, speech-language pathologist and occupational therapist

30. Medical Treatments • Medicines for treating autism are most effective when used in conjunction with behavioral therapies • Treating the three core symptoms of autism (communication difficulties, social challenges and repetitive behavior) has not been met • Difficult because what works well for one individual may not for another

31. The cause of autism is unknown • Treatments are effective for treating associated medical and psychiatric conditions of autism but not the disability itself • More research is needed to determine the cause so more effective treatments can be made and a cure could be discovered.

32. Resources Autism Spectrum Disorder. (2014, January 2). Retrieved January 7, 2014, from Autism Society: http://www.autism-society.org/ What is Autism? (2014, January). Retrieved December 11, 2013, from Autism Speaks: http://www.autismspeaks.org