AUTISM

1. AUTISM What is going on?!

4. What about us? • If the rate of autism is approximately one in 110, how many students should we expect in our school system to have autism? • Counting PreK we have 6050 students. • Thus: 6050 / 110 = 55 • We have 36 certified SPED with autism.

6. History of Diagnosis • Autism was first used in 1916 to describe individuals who had completely withdrawn from the social world. • Leo Kanner wrote about it in 1943 • Hans Asperger wrote about it in 1944 • Was formally recognized in 1980 as “infantile autism” • Name change in 1987 to “autistic disorder” • Asperger’s Syndrome was formally recognized in 1993

8. What’s up with all these names? • Autism Spectrum Disorder (ASD) • High Functioning Autism(HFA) • Asperger’s Disorder (AD) • Asperger’s Syndrome (AS) • Pervasive Developmental Disorder (PDD) • Classic Autism (“CL” in the Ziggurat Model) • “Quirky Kids” (QK)

9. Diagnostic Criteria and Associated Features • A “triad” of symptoms: • Social differences • Repetitive behaviors or obsessive interests • Communication differences These features are present regardless of the level of functioning; yet they are expressed differently depending on the individual characteristics.

12. Common Social Differences • Has difficulty recognizing the feelings and thoughts of others (mindblindness) • Uses poor eye contact • Has difficulty maintaining personal space; physically intrudes on others • Lacks tact or appears rude • Has difficulty making or keeping friends • Has difficulty joining an activity • Is naïve, easily taken advantage of, or bullied

13. More Common Social Differences • Tends to be less involved in group activities than most same-aged peers • Has difficulty understanding other’s nonverbal communication (e.g. facial expressions, body language, tone of voice) • Has difficulty understanding jokes

14. Common Behavior Differences • Expresses strong need for routine or “sameness” • Expresses desire for repetition • Has eccentric or intense preoccupations/absorption in own unique interests • Asks repetitive questions • Seems to be unmotivated by customary rewards • Displays repetitive motor movements (“flaps” hands, paces, flicks fingers in front of eyes, etc.) • Has problems handling transitions and change • Has strong need for closure or difficulty stopping a task before it is completed

15. Communication Differences • Makes sounds repeatedly or states words or phrases repeatedly (non-echolalic) (e.g. humming, “well actually”) • Displays immediate or delayed echolalia (reciting lines from movies, repeating another person’s question or statements, repeating sounds, etc.) • Interprets words or conversations literally/has difficulty understanding figurative language • Has difficulty with rules of conversation (e.g. interrupting others, asking inappropriate questions, poor eye contact, difficulty maintaining conversation) • Has difficulty using gestures and facial expressions • Has difficulty starting, joining, and/or ending a conversation • Has difficulty asking for help

16. More Communication Differences • Makes irrelevant comments • Has difficulty expressing thoughts and feelings • Speaks in an overly formal way • Gives false impression of understanding more than actually does • Talks incessantly • Uses an advanced vocabulary • Uses mechanical, “sing-song” voice, or speech sounds that are unusual in other ways (e.g. prosody, cadence, tone) • Has difficulty following instructions • Has difficulty understanding language with multiple meanings, humor, sarcasm, synonyms • Has difficulty talking about others’ interests

17. Associated Features • Common Sensory Differences • Responds in an unusual manner to sounds (e.g., ignores sounds or overreacts to sudden unexpected noises, high pitched continuous sounds, or complex/multiple noises) • Responds in an unusual manner to pain (e.g., overreacts or seems unaware of an illness or injury) • Responds in an unusual manner to taste (e.g., resists certain textures, flavors, brands) • Responds in an unusual manner to light or color (e.g., focuses on shiny items, shadows, reflections, shows preference or strong dislike for certain colors) • Responds in an unusual manner to temperature

18. Sensory Differences Continued • Responds in an unusual manner to smells (e.g., may comment on smells that others do not detect) • Seeks activities that provide touch, pressure, or movement (e.g., swinging, hugging, pacing) • Avoids activities that provide touch, pressure, or movement (e.g., resists wearing certain types of clothing, strongly dislikes to be dirty,, resists hugs) • Makes noises such as humming or singing frequently

19. Associated Differences • Common Cognitive Differences • Displays extensive knowledge in narrow areas of interest • Displays poor problem-solving skills • Demonstrates poor organizational skills • Withdraws into complex inner worlds/fantasizes often • Is easily distracted by unrelated details – has difficulty knowing what is relevant or makes off-topic comments • Displays weakness in reading comprehension despite strong word recognition ability • Knows may facts and details but has difficulty with abstract reasoning (weak central coherence) • Has difficulty applying learned skills in new settings

20. Cognitive Differences Continued • Has academic skill deficits • Has attention problems • Displays very literal understanding of concepts • Has difficulty understanding the connection between behavior and resulting consequences • Recalls information inconsistently (seems to forget previously learned information)

21. Associated Differences • Common MotorDifferences • Has balance difficulties • Resists or refuses handwriting tasks • Has poor handwriting • Has poor motor coordination • Writes slowly • Has deficits in athletic skills • Walks with an awkward gait • Displays unusual body postures and movements or facial expressions (e.g., odd postures, stiffness, “freezing,” facial grimacing) • Has difficulty starting or completing actions (may require physical or verbal prompting)

22. Associated Differences • Common Emotional Differences • Is easily stressed – worries obsessively • Appears to be depressed or sad • Appears anxious • Exhibits rage reactions or “meltdowns” • Injuries self (e.g., bangs head, picks skin, bites nails until they bleed, bites self) • Makes suicidal comments or gestures • Has difficulty tolerating mistakes • Has low frustration tolerance • Has low self-esteem, makes negative comments about self

23. Emotional Differences Continued • Has difficulty identifying , quantifying, expressing, and/or controlling emotions (e.g., can only recognize and express emotions in extremes) • Has a limited understanding of own and others’ emotional responses • Has difficulty managing stress or

26. Brain Facts Related to Autism • On average, the brain is larger and heavier than the normal brain. • The fusiform face area does not light up typically when processing faces. • The amygdala, which tends to be oversized, does not light up typically when processing faces. • The prefrontal cortex related to empathizing is less active when trying to figure out what another is thinking or feeling.

27. More Brain Facts • Important pathways between areas of the brain needed for processing may be missing or incomplete. • Faces tend to be processed in areas of the brain typically used to process patterns and objects. • Dendrite growth is exceptionally rapid leading to overdevelopment in certain brain areas. • Mirror neurons function normally.

30. White Matter Enlargement • The part of the brain with autism that had expanded the most in size relative to normal brains is the white matter. • White matter consists of the millions of individual nerve fibers that ferry information from one brain region to the next. • (The name white matter derives from the color of the fatty material that insulates the nerve cell fibers as they project throughout the brain.) • The volume change is biggest in the front of the brain, which is the part of the brain most interconnected with all other brain regions.

31. This area is responsible for integrating information from many other brain regions and is where the most abstract (“higher-order”) brain functioning is believed to take place. • This white matter area also develops later than many others and doesn’t reach maturity until the second year of life, if not later. • There are more areas that are bigger on the right than the left side of the brain, making the brain size biased overall to the right half.

34. Synaptic Imbalanceand Critical Periods of Development

35. CONCLUSION • Autism is a “developmental disconnection syndrome” • Long range neural connection from one brain region to another are disrupted

36. Task-related activity “faces” in red, “objects” in green, and “words” in blue

37. Visual Processing of Faces • Toddlers with ASD do not have trouble looking a pictures of faces. • However, they spend more time looking at outside features of the face, such as hair, ears, and neck. • In adults, there is reduced connectivity between the fusiform face area and two other brain regions, the left amygdala and the posterior cingulate

39. “Our working hypothesis is that these children’s increased fixation on mouths points to a predisposition to seek physical, rather than social, contingencies in their surrounding world. They focus on the physical synchrony between lip movements and speech sounds, rather than on the social-affective context of the entreating eye gaze of others. These children may be seeing faces in terms of their physical attributes alone; watching a face without necessarily experiencing it as an engaging partner sharing in a social interaction.”

40. Early Detection • Eye gaze at 9 months of age • Two-year-olds look more at mouths and less at eyes than typicals – amount of time looking at eyes predicts level of social disability