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AUTISM SPECTRUM DISORDERS
Sue Mondak, M.A., CCC-SLP
PREVALENCE OF ASD
Prior to 1990’s: 4-5 per 10,000 for autism
2003 California study: Doubling in last 4 years
CDC 2007: 1 in 150 CDC 2009: 1 in 110 CDC 2012: 1 in 88 CDC 2012: 1 in 54 boys
PREVALENCE (con’t)
More children will be diagnosed with autism this year than with AIDS, diabetes, or cancer combined.
Autism is the fastest growing developmental disorder in the United States.
DEFINITION - Educational
A brain development disorder characterized by impairments in social interaction, communication, and restricted and repetitive behavior, typically appearing during the first three years of life.
DEFINITION – CENTERS FOR DISEASE CONTROL (CDC)
Autism Spectrum Disorders are a group of developmental disabilities that can cause significant social, communication, and behavioral challenges.
Symptoms can range from mild to severe.
DEFINITION - DSM-IV
Qualitative impairments in social interaction
Qualitative impairments in communication
Restricted repetitive and stereotyped patterns of behavior, interests, and activities
DEFINITION (con’t)
Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3: Social Interaction Language as used in social
communication Symbolic or imaginative play
ASPERGER SYNDROMEDSM-IV
Qualitative impairments in social interaction
Restricted repetitive and stereotyped patterns of behavior, interests, and activities
Clinically significant impairments in social, occupational, or other important areas of functioning
ASPERGER SYNDROM (con’t)
No clinically significant general delay in language
No clinically significant delay in cognitive development or in the development of age appropriate self help skills, adaptive behavior (other than social interaction) and curiosity about the environment in childhood
PROPOSED REVISION FOR DSM - V
Rett’s disorder removed from autism category
All pervasive developmental disorders will be called Autism Spectrum Disorder
Minor changes to criteria
CAUSES OF AUTISM
No one knows exactly why, but the brain develops differently in people with autism.
It is now widely accepted by scientists that a predisposition to autism is inherited.
It is likely that both genetics and environment play a role.
GENETICS Researchers have identified a number
of genes associated with ASD. Identical twin studies show that when
one twin is affected there is up to 90% chance the other twin will be affected.
In families with one child with ASD, the risk of having a second child with the disorder is approximately 5%.
ENVIRONMENTAL FACTORS A number of pre or post-natal
environmental factors have been claimed to contribute to ASD or exacerbate it’s symptoms with little evidence to support these claims Certain foods (Glutton free diets) Infectious disease Heavy metals (Detox methods) Solvents Diesel exhaust
ENVIRONMENTAL FACTORS (con’t)
PCB’s Phthalates & phenols used in plastic
products Pesticides Alcohol Smoking Illicit drugs Vitamin deficiencies (Supplements) Vaccines
A recent Danish study found that pregnant women who had the flu were 2x more likely to have a child with autism
EARLY WARNING SIGNS: No big smiles or other warm, joyful
expressions by 6 months of age or after No back and forth sharing of sounds,
smiles, or other facial expressions by 9 months of age
No babbling by 12 months of age No back and forth gestures such as
pointing, showing, reaching, or waving by 12 months of age
WARNING SIGNS (con’t)
Lack of eye contact and response to name
No words by 16 months of age No meaningful two word phrases
(not including imitating or repeating) by 2 years of age
Any loss of speech, babbling, or social skills at any age
SOCIAL RECIPROCITY
Definition: The ability to initiate and respond in social interactions
SOCIAL RECIPROCITY IN CHILDREN WITH AUTISM
Less frequent spontaneous bids for communication
Fewer back and forth turns in interaction Fewer gestures Inability to recognize communication
breakdowns More reliance on structured situations for
conversation More passive conversational style
SOCIAL RECIPROCITY IN OLDER CHILDREN WITH AUTISM
Difficulty maintaining conversations with relevant remarks, questions, or comments
Difficulty providing necessary background information for conversations
Difficulty engaging in conversations appropriate to social context or interests of others
NONVERBAL COMMUNICATIONIN YOUNG CHILDREN WITH ASD
Limited range of conventional gestures and vocalizations
Reliance on contact gestures such as hand leading, pulling, or physical manipulation
Delayed or absent conventional gestures or distal gestures (pointing)
Use of problem behaviors to communicate (frequent tantrums)
NONVERBAL COMMUNICATION IN OLDER CHILDREN WITH ASD
Literal understanding and use of verbal communication
Limited understanding of sarcasm and nonliteral language
Monotone speech or atypical prosody
SYMBOLIC PLAY
Limited functional use of objects with younger children
Repetitive or rigid play Limited ability to represent objects
when younger and social situations when older
VERBAL COMMUNICATION IN CHILDREN WITH ASD
Reliance on immediate or delayed echolalia
Reliance on rote memory rather than semantic understanding for longer utterances
Persistent difficulty with comprehension
VERBAL COMMUNICATION (con’t)
Difficulty generalizing meaning of words beyond contexts in which they were learned
Difficulty learning words other than nouns at early stages
Difficulties with phonology or motor planning for speech
LITERACY SKILLS
Difficulty observing or imitating functional use of books
Limited understanding or use of story grammar
Poor reading comprehension Hyperlexia
SENSORY DIFFICULTIES Difficulty processing sensory input Senses may be hyper-sensitive or hypo-
sensitive; usually a combination Tastes Smells Touch Sounds Sights Movement and Balance Body Position/Muscle Control
SENSORY REGULATION Use of immature or atypical self-
regulation strategies Chewing on clothing Carrying objects Vocal play Rocking Visual Stimulation Covering ears / or dropping objects to hear
the sound Smelling toys or other objects frequently
ASSESSMENT
Primary assessment is through observation of communication, behavior and social interaction
Parental input and developmental history are essential components of the evaluation
ASSESSMENT (con’t)
Screening tool: M-CHAT (doctors often complete in
office) Used to identify children at risk, not
to determine diagnosis Child who fails 3 total items or 2
critical items (2,7,9,13,14,15) fail the M-CHAT
ASSESSMENT (con’t)
ADOS: Autism Diagnostic Observation Schedule A semi-structured, standardized
assessment of communication, social interaction, and play or imaginative use of materials
DIAGNOSIS
May obtain a medical diagnosis from child Psychiatrist, or behavioral pediatrician
Educationally: must meet eligibility qualifications
EDUCATIONAL ELIGIBILITY
See Michigan’s Definition of Autism Spectrum Disorder Handout
INTERVENTION STRATAGIES
Visual Schedules Picture Exchange System (PECS) Sensory Integration Therapy (OT’s)
INTENSIVE INTERVENTIONS
Behavioral / ABA (Applied Behavior Analysis)
Developmental Greenspan/Weider DIR/Floortime 6 Functional Developmental Levels
Combined Denver Early Start Model
DIR Framework (Greenspan/Weider)
Developmental, Individual differences and Relationship based
One-on-one intensive engagement Child centered-’meet them where
they’re at’ DIR is the theory, “Floortime” the
practice 15-25 hour/week beside school 6 Functional developmental levels
6 FUNCTIONAL DEVELOPMENTAL LEVELS
Self regulation and shared attention(FDL1)
Engagement (FDL 2) Two-way Communication (FDL 3) Complex two-way Communication (FDL 4) Shared Meanings & Symbolic Play (FDL 5) Emotional Thinking (FDL 6)
P.L.A.Y. Project ModelPlay and Language for Autistic Youngsters
Developed by Dr. Richard Solomon from the University of Michigan in 2000
Based on Greenspan’s Floortime/D.I.R. Model
Developed due to no intensive services publicly in Michigan
Community based, family centered, cost effective
Now in 27 states and 9 countries Attempting to bring this to our area
P.L.A.Y. Project Values Family and child centered Interventions often in the natural
environment of the home Parent empowerment model Relationship based Playful and fun Addresses the core deficit: Social
Impairment
DEVELOPMENTAL METHODS AND OUTCOMES OF THE PROJECT
Contingent, reciprocal, social interactions Follow the child’s lead, interests, and/or
intent Shared social attention Joyful relating Simple and complex nonverbal gestures Long interactive sequences of
spontaneous verbal communication Symbolic language related to affect
P.L.A.Y. Home Consultation
Monthly half day visits Coach, model, and support parents
to Play Video/written feedback
GOAL:
To move the child out of their Comfort Zone, into interactional engagements with others
To move the child from their current functional developmental level to the highest functional developmental level possible
COMFORT ZONE What the child does when you let them
do whatever they want to do Focused on repetitive interests Tuned out; “In their own world” Examples:
Lining up toys Visually self stimming on wheels, lines,
objects Obsessed with numbers and letters Stuck on same topic: planets, Pokemon
ACTIVITIES FOR FUNCTIONAL DEVELOPMENTAL LEVELS 1 & 2
Rolling child up in a rug Swinging in a blanket Tickling Gentle wrestling Playing peek-a-boo Sensory Motor level
ACTIVITIES FOR FUNCTIONAL DEVELOPMENTAL LEVELS 3 & 4
Chase: “I’m gonna get you” Get the bubbles, balloon, etc. Ball play (rolling it back and forth) Very simple pretend play: phone to
ear, cars crash Being silly
ACTIVITIES FOR FUNCTIONAL DEVELOPMENTAL LEVELS 5 & 6
Pretend play: Dress up, tea party Real Hide-n-Seek (not just peek-a-
boo) Reading books – looking at
pictures and a telling a simple story
Duck, duck, goose
RESEARCH The P.L.A.Y. Project is a form of Intensive
Developmental Intervention (IDI) Studies have found that Intensive
Interventions that incorporate parent training, and focus on the core deficit of ASD (social impairment) show significant improvement in children with autism
Demonstrated improvements in parents skill in interaction and child functional development
EEG brain scans confirm improvements