aaa section 03 autism spectrum disorder ver 03 2013

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‘Autism, Asperger’s & ADHD’ (6PS055)‘ADHD, Autism & Asperger’s’ (6PS077)

Lecturer: Simon BignellSection: 3 of 11

Autism Spectrum Disorder

Updated for 2013

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Introduction to the Section.• What is Autism & DSM-V change?• Symptoms of autism.• Prevalence of autism.• How Autism was first recognised.• Assessment.• Diagnosis.• Questions.

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Learning Outcomes of this Section.On completion of the Section and with

independent study you should be able to:

1. Understand the main symptoms, variations and diagnostic criteria relating to autistic disorder.

2. Be able to describe autistic disorder in detail.

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Autism Spectrum Disorder.A continuum that… “…ranges from the most

profoundly physically and mentally retarded person ... to the most able, highly intelligent person with social impairment in its subtlest form as his only disability. It overlaps with learning disabilities and shades into eccentric normality.” The Autistic Spectrum (2003) Lorna Wing

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AutismNo single cause;

no single cure.

Hence: A spectrum, a continuum, a

syndrome.

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What Is Autism?

• Autism is a developmental disability that significantly affects a person’s verbal and nonverbal communication, social interactions, and education performance. It is generally evident before age 3.

• Characteristics include engagement in repetitive activities & stereotyped movements, resistance to environmental change or changes in daily routines, & unusual responses to sensory experiences.

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What Is Autism?

• Considered a continuum whereby it can be found with various degrees of impairment and functioning (Wing & Gould, 1979).

• The probability of a second child being diagnosed with ASD is 1 in 20.

• A life-long pervasive developmental disorder with genetic susceptibility.

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What Is Autism?• A syndrome – cluster of symptoms

appearing in a particular combination (Boucher & Pennington, 1991).

• A spectrum of disorders. Ranges from low functioning – high functioning / Asperger's Disorder (Asperger's Syndrome).

• Presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests.

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The DSM-IV includes five types of disorder under the term ‘Pervasive Developmental Disorder’ PDD.

1) Autistic Disorder*.2) Rett’s Disorder.3) Childhood Disintegrative Disorder.4) Asperger’s Disorder*.5) Pervasive Development Disorder

Not Otherwise Specified*.* Mainly these form the Autistic spectrum ASD.

What Is Autism (under DSM-IV)?

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The major change to the diagnosis of autism is the use of the umbrella term of ‘Autism Spectrum Disorder’. [from May 2013]

The DSM-V will combine the currently separate diagnoses of Autistic Disorder, Asperger's Disorder, Pervasive Developmental Disorder-not otherwise specified (PDD-NOS) and Childhood Disintegrative Disorder.

What Is Autism (under DSM-V)?

The age of onset will be more flexible, allowing for older children to be diagnosed.

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What Is Autism?“There are no clearly established guidelines for

measuring the severity of a person's symptoms. Therefore, the line between Autism and PDDNOS is blurry.” (Boyle, 1995).

Other features often present:• An insistence on sameness.• Attentional and perceptual abnormalities –

notice fine details and very small changes in their environment.

• Difficulties generalising learning to new situations.

• Can have exceptional talents and abilities (savant abilities).

What Is Autism?

• The so-called ‘triad of impairment’ summarises the difficulties of the autistic child but the actual manifestation of these can vary.

Restricted, repetitive and stereotyped patterns of

behaviour.

Impairment in social interaction.

Impairment in verbal and non verbal communication.

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The Triad Of Impairment.

1. Impairment in social interaction.

• Difficulties in making sense of the world can lead to behaviour that appears bizarre and antisocial.

• May withdraw totally or may attempt to interact but may upset, bore or irritate others.

• Problems in forming relationships.

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2. Impairment in verbal and non verbal communication.

• Difficulties in receptive language – may take everything literally.

• Difficulties with metaphor.• Difficulties with pragmatics - don’t

easily understand facial expressions, tone of voice, gesture (Happè, 1993; Tager-Flusberg, 2001).

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3. Restricted, repetitive and stereotyped patterns of behaviour.

• Find change very difficult.• Often develop obsessive interests.• Rigid and restricted behavioural

patterns – very set in their routines (Happè, 1993).

• Restricted repertoire of interests.

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What Does Autism Look Like?

• Poor eye contact.• Doesn't seem to know how to

play with toys.• Excessively lines up toys or other

objects.• Is attached to one particular toy

or object.• Doesn't smile.• At times seems to be hearing

impaired.

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What Does Autism Sound Like?

• The child doesn’t point, make baby babble or gestures by one year of age.

• Usually the child doesn’t speak one word by 16 months of age (however, some have language and lose it around 2 years of age.).

• Does not combine two words by 2 years of age.

• Does not respond to name when called.• Loses language or social skills.

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What Does Autism Feel Like?

• Hypersensitive to sounds:– Imagine chairs sliding on the floor, keys on a

keyboard clicking, someone chewing, a fly buzzing outside the window all coming at you at one time.

• Has a routine and feels lost if the routine is changed.

• Hypersensitive to touch.• Hypersensitive to light.• Takes language literally:

– If a police officer says “freeze” the person with autism thinks: that’s silly…it’s not freezing.

• Thinks in pictures.

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Prevalence Of Autism.• Went from 1 in 2500, to 1 in 1000, to 1 in

166 over the past decade.• Autism is now more common than

childhood cancer, Down’s syndrome, spina bifida or cystic fibrosis.

• Boys are affected 4 times as often as girls but unknown as to why.

• 1 out of 68 families will have a child with autism.

• Growing at a rate of 10-17 percent per year (it is thought).

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Prevalence of Autism

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"Autism is not a modern problem, even though it has only been recognised in modern times. In view of the short history of psychiatry, and the even shorter history of child psychiatry, we know that a disorder recently described is not necessarily a recent disorder. An increase in diagnosed cases does not necessarily mean an increase in cases."

Autism: Explaining the Enigma (1989) by Uta Frith.

Increasing Incidence Of Autism?

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Increasing Incidence Of Autism?

• Science still baffled over its aetiology (genetic origin).

• Diagnosis has been purely behaviourally bases.

• New criteria for diagnosis may account for the apparent increase in its prevalence.

• Currently estimates vary wildly.

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How Autism was First Recognised.

• Leo Kanner and Hans Asperger who, independently of each other, published accounts of this disorder.

• These publications, Kanner's in 1943 and Asperger’s in 1944, contained detailed case descriptions and also offered the first theoretical attempts to explain the disorder.

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• Both authorities (Leo Kanner and Hans Asperger) believed that there was present from birth a fundamental disturbance which gave rise to highly characteristic problems.

• Kanner, working in Baltimore, and Asperger, working in Vienna, saw cases of strange children who has in common some fascinating features.

• Above all the children seemed to be unable to entertain normal affective relationships with people.

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How Autism was First Recognised.• Kanner’s paper has become the most quoted in the whole literature on autism.

• Asperger’s paper, written in German, and published during the second world war, was largely ignored.

• Asperger’s definition of autism or, as he called it, ‘autistic psychopathy’ is far wider than Kanner's.

• Having this special category has proved clinically useful.

• The belief has grown that Asperger described quite a different type of child, not to be confused with the one Kanner described. This is not the case.

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• Both Kanner and Asperger choose the word ‘autistic' in order to characterise the nature of the underlying disturbance.

• In fact, it is not really a coincidence, since the label had already been introduced by the eminent psychiatrist Eugen Bleuler in 1911.

http://en.wikipedia.org/wiki/Image:Bleuler.png

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How Autism was First Recognised.• In the 70s, knowledge of Autism begun to

spread to Sweden. The first autistic classes within special education were started in the middle of the 70s.

• The work of Asperger did not become known until the end of the 1980s when his book was translated into English.

• Kanner's work and Bettelheim's ‘refrigerator mother’ theory of autism were quite often confused and it was generally accepted that autistic children had frigid mothers.

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Assessment & Diagnosis.• Assessed on a behavioural basis.• ICD-10 (11th edition, due in 2015) and

DSM-IV (shortly DSM-V); tick-list medical approach.

• Missed diagnosis and misdiagnosis.– Multiple referral routes.– Pressures on LEA resources.– Multiple assessment protocols.• There’s also pressure NOT

to diagnose (limited resources at Local Authority level).

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Assessment & Diagnosis.

The NICHD lists these five behaviours that signal further evaluation is warranted:– Does not babble or ‘coo’ by 12 months.– Does not gesture (point, wave, grasp) by

12 months.– Does not say single words by 16 months.– Does not say two-word phrases on his or

her own by 24 months.– Has any loss of any language or social

skill at any age.

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Assessment & Diagnosis.• Assessment for the purpose of diagnosis

typically occurs in clinics or private practices and is led by psychiatrists, psychologists, or physicians.– CARS rating system (Childhood Autism

Rating Scale).– The Checklist for Autism in Toddlers

(CHAT).– The Autism Screening Questionnaire.– The Screening Test for Autism in Two-

year Olds.

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Assessment & Diagnosis.• Thorough assessment depends on

information gathered through a variety of methods.– Professionals.– Family members.– Educators.

• There is not a single test that when used alone can provide a definitive diagnosis of an autism spectrum disorder.

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Assessment & Diagnosis.• It’s easier to ‘spot’ autism at the low

functioning end of the spectrum.• High functioning children do adapt .• Early intervention is critical.

– Younger children have a greater degree of brain plasticity (Edelman, 1992).

• Late screening:– Very few tools sensitive to adolescent/adult

diagnosis.– Self-diagnosis common (AQ published on

web).

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Is There A Cure For Autism?• No – it is a lifelong disorder.

– Some suggest otherwise but there’s a lack of evidence.

• But people with Autism often make good progress and develop coping strategies.

• Range of therapies and treatments but no real consensus on what is most effective.

• Because there is a wide variability in people with Autism there is a need to develop an individual treatment and management plan.

aaa section 03 autism spectrum disorder ver 03 2013

Education