DSM-IV Autism Spectrum Disorders: Then

1. DSM-IV Autism Spectrum Disorders: Then • Autism previously classified as one of five Pervasive Developmental Disorders (American Psychiatric Association, 2000): • Autistic disorder • Asperger’s disorder • Rett’s disorder • Childhood Disintegrative Disorder • Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) .

2. DSM-5 Diagnosis Criteria for ASD Currently, or by history, must meet criteria A, B, C & D A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays. B. Restricted, repetitive patterns of behavior, interests, or activities. C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities D. Symptoms together limit and impair everyday functioning.

3. From DSM-IV to DSM V

4. Summary of Important Changes • Single Diagnosis: Autism Spectrum Disorder • Out Goes Asperger’s syndrome & Rett’s Disorder • Requires symptoms to begin in “early childhood” rather than before 3. • For more in-depth analysis please consult other slides on new criteria and DSM-V

5. Common Diagnosis Yet Drastic Differences in Behaviours…. -Varying levels of ID 20% IQ above 70, 20% 50-70, 60% below 50 Determining IQ difficult b/c people w/ autism tend to: • Score low on verbal and abstract reasoning tasks • Score high on tasks requiring memory/visual spatial or manipulative skills -Hyperactivity -Aggression -Self-injurious behaviours -Seizures – 1 /4 (NIMH, 2008) - Brain unable to balance sensory input - Highly attuned or have painful sensitivity to certain sounds, textures, tastes, and smell -Temper tantrums -Sleep disturbances

6. High Functioning Autism (Formerly Associated with Asperger’s Syndrome) • Milder & more functional type of ASD. • Normal IQ - Often exceptionally talented in specific area. • Variety of behaviours ranging from mild to severe including: • Lack of social skills/transitions • Obsessive behaviours • Difficulty reading nonverbal cues/body language • Over sensitivity to sounds, tastes and bothered by sounds/lights others do not notice. • ‘Motor clumsiness’ (50%)

7. Savant Syndrome • Approx 10% • 50% of all people with Savant syndrome have autism. • Ability to perform musical, artistic, computational, athletic, or other skills at exceptional levels without benefit of instruction. • May be genetic or acquired (Treffert, 2009)

8. How Has ASD Been Viewed In The Past? 1940-1960s: Dr. Leo Kanner described autism for the first time (1943) Medical model saw children as schizophrenic. 1960s Social model more effort to identify symptoms/treatment. 1970s Research focused on medications: LSD/electric shock/and behavior change techniques. 1990s-Present: Behavior therapy leading approach http://www.autism-pdd.net/autism-history.html/http://www.webmd.com/brain/autism/history-of-autism.

9. Why Has ASD Become Such a Topic of Discussion in Recent Times? • Current prevalence: Nearly 1/110 (CDC, 2010). • Nearly 200,000 Canadians with ASD. • 4x more common in males (Horvat et al., 2008) • Dramatic increase in cases. • Revised diagnostic criteria alone does not seem to explain rise….

10. What Causes Behaviours Associated With ASD? • Specific cause remains unknown. • Hypotheses include: • - Neurobiological (Linked to childhood disease e.g. rubella, encephalitis or metabolic/brain injury) • - Genetic (Specific gene not yet found) • - Environmental “Trigger” Heavy metals e.g. mercury (Minshew et al., 2001), Thimerosal in vaccines?(Rabinovitz, 2009).

11. When/How is ASD First Evident/Diagnosed??? • ASD often detected in “early childhood” by three – occasionally as early as 18mths. • Much earlier than 20yrs ago. • Comprehensive evaluation by a multidisciplinary team e.g. pediatrician/psychologist/psychiatrist/social worker/PT/OT. • Based on: • History; • Diagnostic tools:Childhood Autism Rating Scale (CARS), Autism Diagnostic Interview - Revised (ADI-R) AND • Observations: Autism Diagnostic Observation Schedule (ADOS-G)

12. Intervention Approaches • Early intervention may be effective at: • Improving development (motor, language & behaviour). • Prevention of secondary conditions: anxiety, depression, obesity etc (.Filipek, Accardo, et al., 1999). • Usually multifaceted – combined w/medication to manage symptoms. • Variety of motor learning/educational approaches (see image)

13. PECS

14. Planning the Physical Activity Program • Less active than peers (Yu-Pan, 2008). • Respond positively to moderate-vigorous physical activity e.g. Improve exercise capacity, fitness and lower BMI (Pitetti et al., 2007). • Individualized assessment key. • Challenging task for teachers to meet needs & requires initiative/imagination... • Goal of assessment two-fold (1) Determine what a child needs to learn AND (2) how best to present and teach each child

15. Applying TEACCH in Physical Education/Activity • Treatment and Education of Autistic and Related Communication Handicapped Children. • Structured/routine-based models for learning. • Multifaceted approaches and create program based on EACH child’s level of function/interests. • Adapt environment to accommodate specific needs of the child (Mesibov, 2006). • Behaviour changes based on environment.

16. Recommendations For Physical Activity (TEACCH) • Visual boundaries minimize confusion (Blubaugh & Kohlmann, 2006) e.g. Colour coded areas, tape. • Familiar routine crucial(Boswell & Decker, 2000). • Remove all extra stimuli. • Limit verbal directions • Visual schedule e.g. Cue cards/pictures of activities make transitions easier (Schultheis et al., 2000). • Individuals will often NOT respond to test directions = Inaccurate scoring. • Safe activities as unaware of danger. • Always consider... • Social interaction and social learning Impairments • Language and speech impairments • Difficulty responding appropriately • Motor planning and executive control problems • Unusual responses to sensory input • Pathological resistance to change • Attention problems (Need for quick. Transitions)